1194664839 NPI number — DR. TOMONARI MAXIMILIAN SHIMODA MD

Table of content: DR. TOMONARI MAXIMILIAN SHIMODA MD (NPI 1194664839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194664839 NPI number — DR. TOMONARI MAXIMILIAN SHIMODA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIMODA
Provider First Name:
TOMONARI
Provider Middle Name:
MAXIMILIAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194664839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 VERNY TOWER, 2-14-3 SHIOIRI
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOKOSUKA
Provider Business Mailing Address State Name:
KANAGAWA
Provider Business Mailing Address Postal Code:
2380042
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11234 ANDERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92350-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-558-6248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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