Provider Demographics
NPI:1467999474
Name:JIMBO, MASAYA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MASAYA
Middle Name:
Last Name:JIMBO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:2211 CHAPEL AVE W STE 301
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2062
Practice Address - Country:US
Practice Address - Phone:856-665-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12260300208800000X
MN28964208800000X
MN64110208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology