Provider Demographics
NPI:1386729788
Name:ALLERGY-ASTHMA CLINIC PC
Entity type:Organization
Organization Name:ALLERGY-ASTHMA CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-365-9146
Mailing Address - Street 1:4301 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3146
Mailing Address - Country:US
Mailing Address - Phone:319-365-9146
Mailing Address - Fax:319-362-7285
Practice Address - Street 1:4301 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3146
Practice Address - Country:US
Practice Address - Phone:319-365-9146
Practice Address - Fax:319-362-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty