DR. KOZUE SHIMABUKURO (NPI# 1134334600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134334600 |
| Entity Type | Individual |
| Full Name | DR. KOZUE SHIMABUKURO |
| Credential | M.D. |
| Practice Address |
11175 Campus St Cp A1117 Loma Linda CA 92350-1700 |
| Practice Telephone | 9095584250 |
| Mailing Telephone | 9095584250 |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2016-07-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | M-1938 | GU | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | A101076 | CA | Allopathic & Osteopathic Physicians |
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
M-1938 | GU | Allopathic & Osteopathic Physicians |
| N | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
A101076 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
11175 CAMPUS ST CP A1117 |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92350-1700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821181553 | Huitzilin Mauricio Olmecah | Neurological Surgery | 11175 Campus St, Department of Neurology, Coleman Pavilion - Rm. 11108, Loma Linda, CA 92350-1700 | 2006-10-02 |
| 1518490804 | Erika Kristine Reel | Student in an Organized Health Care Education/Training Program | 11175 Campus St, Cp-11108, Loma Linda, CA 92350-1700 | 2017-04-04 |
| 1295268530 | Kenna Brooke Schnarr | General Practice | 11175 Campus St, Coleman Pavilion, Room #11105, Loma Linda, CA 92350-1700 | 2017-04-04 |
| 1578004156 | Michelle Tanzil | Obstetrics & Gynecology | 11175 Campus St, Loma Linda, CA 92350-1700 | 2017-03-15 |
| 1639527286 | Leah Marie Humann | Student in an Organized Health Care Education/Training Program | 11175 Campus St, #21108, Loma Linda, CA 92350-1700 | 2016-05-24 |
| 1205281540 | Linninea Ebell | Nurse Practitioner | 11175 Campus St, Suite 11120, Loma Linda, CA 92350-1700 | 2016-04-23 |
| 1891182093 | Stewart Haven Barlow | Obstetrics & Gynecology | 11175 Campus St, Loma Linda, CA 92350-1700 | 2015-04-25 |
| 1295149771 | Shrinkhala Srivastava | Pediatrics | 11175 Campus St, Loma Linda, CA 92354 | 2014-06-12 |
| 1700298437 | Loma Linda University Medical Center | General Acute Care Hospital | 11175 Campus St, Loma Linda, CA 92350-1700 | 2014-05-29 |
| 1306263587 | Mallory Cohen | Pediatrics | 11175 Campus St, Cp- A1120, Loma Linda, CA 92350-1700 | 2014-03-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164059010 | Stephanie Abandy | Student in an Organized Health Care Education/Training Program | 11262 Campus Street - West Hall, West Hall, Loma Linda, CA 92350 | 2020-03-23 |
| 1275911844 | Rosemarie Florian | Internal Medicine | 11234 Anderson St Rm 1503, Loma Linda, CA 92350 | 2015-05-14 |
| 1235525403 | Diana Derosa Villarreal | Pediatrics | 11175 Campus St. Cp-a1111, Department of Pediatrics, Loma Linda, CA 92350 | 2015-04-14 |
| 1609212919 | Daniel Eldridge Smith | Surgery | 11175 Campus St # 21111, Loma Linda, CA 92350 | 2013-05-14 |
| 1992057269 | Hildemar Feliciano Dos Santos | Nutritionist | 25040 Stewart Street, Loma Linda, CA 92350 | 2012-10-10 |
| 1184910762 | Kristyn Anne Mannoia | Surgery | 11234 Anderson Ave Ste 2100, Loma Linda, CA 92350 | 2011-06-22 |
| 1760774947 | Loma Linda University | Special Hospital | 1234 Anderson Street, Gme Office Csp 21005, Loma Linda, CA 92350 | 2011-05-06 |
| 1144547977 | Andrei Radulescu | Surgery | 11175 Campus St Ste 21111, Loma Linda, CA 92350 | 2010-05-04 |
| 1619102845 | Wing Sze Esther Yung | Surgery | 11175 Campus Street #21111, Loma Linda Universiy Healthcare System, Loma Linda, CA 92350 | 2009-05-18 |
| 1679720734 | Ronald Lee Young | Dentist | 11092 Anderson Streeet, Llu School of Dentistry, Loma Linda, CA 92350 | 2008-08-20 |
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| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699093880 | Richard P Lion | Pediatrics | 11234 Anderson St Rm 5763, Loma Linda, CA 92354-2804 | 2010-05-12 |
| 1417164427 | Jim Hajime Eguchi | Pediatrics | Llumc, House Staff Office Cp 21005, 11234 Anderson St, Loma Linda, CA 92354 | 2007-05-17 |
| 1942648357 | Thant Zaw Lin | Pediatrics | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2013-06-06 |
| 1154672244 | Asma Razavi | Pediatrics | 11234 Anderson St, Loma Linda, CA 92354-2804 | 2012-09-28 |
| 1316112386 | Daniel Noriega | Pediatrics | 11234 Anderson St, House Staff Office Cp 21005, Loma Linda, CA 92354-2804 | 2008-04-29 |
| 1942223508 | Stephen B Treiman | Pediatrics | 11370 Anderson St, Ste B-100, Loma Linda, CA 92354-3450 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417368804 | Sara Aghamohammadi | Pediatrics | 4650 W Sunset Blvd # Ms 3, Los Angeles, CA 90027-6062 | 2014-05-19 |
| 1023367422 | Batool Alsheikh | Pediatrics | 6235 N Fresno St Ste 103, Fresno, CA 93710 | 2012-08-31 |
| 1558505719 | Ryan Richard Taylor | Pediatrics | Mattel Childrens Hospital At Ucla, 10833 Le Conte Ave., 12-494, Mdcc, Los Angeles, CA 90095-0001 | 2009-04-30 |
| 1871737270 | Shan Lyn Ward | Pediatrics | 3333 California St # S110, San Francisco, CA 94118-1981 | 2009-04-29 |
| 1932341641 | Anas Al Kawass | Pediatrics | 17100 Euclid Street, Picu, Fountain Valley, CA 92708 | 2009-03-26 |
| 1497996649 | Andreas Schwingshackl | Pediatrics | Rrmc 400 Westwood Blvd, Los Angeles, CA 90095-2113 | 2009-03-18 |
| 1588804801 | Carol Elizabeth Nicholson | Pediatrics | 6461 Zuma View Pl, #149, Malibu, CA 90265-4495 | 2009-02-26 |
| 1831355320 | Niveditha Vilasagar | Pediatrics | 4867 W Sunset Blvd Fl 5, Los Angeles, CA 90027-5969 | 2008-08-04 |
| 1154519072 | Eloa S. Adams | Pediatrics | 275 W Macarthu, Oakland, CA 94611-5641 | 2007-10-04 |
| 1770787046 | Samer Yousfi | Pediatrics | 1000 Carson Street, Harbor-ucla Medical Center, Torrance, CA 90509 | 2007-06-12 |
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| City | LOMA LINDA |
| Zip Code | 92350 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.