Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC16449 | CA |
N | 111NS0005X | Chiropractic Sports Physician | DC16449 | CA |
NPI | 1275562985 |
---|---|
Provider Name | Mr. Shawn Isao Kimura |
First Address | Los Angeles, CA 90048-4308 |
Second Address | Los Angeles, CA 90048-4308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 01/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AC6670 | ACUPUNCTURE LICENSE NUMBE (01) | CA |
DC16449 | (02) | CA |