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NPI Code Detail

MEDICARE: DR. WILLIAM PAUL FUKUDA M.D.

MEDICARE: DR. WILLIAM PAUL FUKUDA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA66117CA

General Provider Information

NPI Number : 1396701850
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM PAUL FUKUDA M.D.
Provider Business Mailing Address
First Line : 400 NEWPORT CENTER DR
Second Line : SUITE 608
City : NEWPORT BEACH
State : CA
Zip : 92660-7601
Country : US
Telephone Number : 949-644-3551
Fax Number : 949-718-6742
Provider Business Practice Location Address
First Line : 400 NEWPORT CENTER DR
Second Line : SUITE 608
City : NEWPORT BEACH
State : CA
Zip : 92660-7601
Country : US
Telephone Number : 949-644-3551
Fax Number : 949-718-6742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 07/08/2007

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