Provider Demographics
NPI:1962109702
Name:SHIMAMURA, JUNICHI (MD)
Entity type:Individual
Prefix:MR
First Name:JUNICHI
Middle Name:
Last Name:SHIMAMURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 NORTH DECATUR RD NE
Mailing Address - Street 2:UNIVERSITY INN AT EMORY UNIT 410
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:678-920-4471
Mailing Address - Fax:
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324555208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery