Provider Demographics
NPI:1902564396
Name:KOJIMA, SHIHO
Entity Type:Individual
Prefix:
First Name:SHIHO
Middle Name:
Last Name:KOJIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHIHO
Other - Middle Name:
Other - Last Name:KOJIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AANP
Mailing Address - Street 1:4657 ENSENADA DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5413
Mailing Address - Country:US
Mailing Address - Phone:424-230-4729
Mailing Address - Fax:
Practice Address - Street 1:23181 VERDUGO DR STE 103A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1313
Practice Address - Country:US
Practice Address - Phone:949-366-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty