Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G54101 | CA |
NPI | 1164429015 |
---|---|
Provider Name | Dr. Roy Masami Fujitani |
First Address | Orange, CA 92868-2903 |
Second Address | Orange, CA 92868-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 19/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BF5006083 | DEA LICENSE NO. (01) | |
G32894 | (02) | |
G54101 | MEDICAL LICENSE (01) | CA |