Provider Demographics
NPI:1053035584
Name:ERI SHIMIZU M.D. LLC
Entity type:Organization
Organization Name:ERI SHIMIZU M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMIZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-500-8420
Mailing Address - Street 1:115 KAMAIKI CIR
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3154
Mailing Address - Country:US
Mailing Address - Phone:808-500-8420
Mailing Address - Fax:
Practice Address - Street 1:270 HOOKAHI ST STE 305
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1466
Practice Address - Country:US
Practice Address - Phone:808-435-6262
Practice Address - Fax:877-795-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center