Keiko Lilly Mimura, MSN, APRN, BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

14487 Issued in CA

Practice address

11500 Nimitz Ave
Los Angeles, CA 90049-3566

Phone

(424) 832-8368

Fax

(424) 832-8270

NPI assigned

Jun 13, 2006

Last updated

May 21, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Temima HealthcareGroup PAC ID 9133650245, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Temima Healthcare

  • General Practice Physician
  • Beverly Hills, CA
  • NPI 1245078054
  Medicare reassignment Care Compare group NPD
• Minghsun Liu, M.D., PC

  dba Woundtech of California

  • Infectious Disease Physician
  • Los Angeles, CA
  • NPI 1518309368
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1932142544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 NIMITZ AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900493566",
            "telephone_number": "424-832-8368",
            "fax_number": "424-832-8270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 NIMITZ AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900493566",
            "telephone_number": "424-832-8368",
            "fax_number": "424-832-8270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMURA",
        "first_name": "KEIKO",
        "middle_name": "LILLY",
        "credential": "MSN, APRN, BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "14487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Alexandra Mims
• Ignatio Lionel Mims
• Jasmine Mims
• Kashonia Mims
• Akiko Mimura-Lazare, LCSW
• Jenny Min Din
• Min Hee Oh, DDS, Inc. (Avenue Dental)
• Min Roh DDS Dental Corporation
• Min S. Park, M.D., Inc.
• Min Seok Kim DDS Inc (Premiere Dental Care)

• Gerontology Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.