1093809790 NPI number — BRUCE JOHN KIMURA M.D.

Table of content: (NPI 1174785646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093809790 NPI number — BRUCE JOHN KIMURA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMURA
Provider First Name:
BRUCE
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1093809790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 512
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-297-0014
Provider Business Mailing Address Fax Number:
619-297-1014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-297-0014
Provider Business Practice Location Address Fax Number:
619-297-1014
Provider Enumeration Date:
10/03/2006

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: 207RC0000X , with the licence number:  G69109 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00G691090 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G391091 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHC137936 . This is a "XRAY FLUROSCOPY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com