Healthcare Provider Details

I. General information

NPI: 1356313456
Provider Name (Legal Business Name): KEVIN DEL FUJIKAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 SUNRISE BLVD STE H
FAIR OAKS CA
95628-4941
US

IV. Provider business mailing address

4944 SUNRISE BLVD STE H
FAIR OAKS CA
95628-4941
US

V. Phone/Fax

Practice location:
  • Phone: 916-966-8158
  • Fax: 916-966-8118
Mailing address:
  • Phone: 916-966-8158
  • Fax: 916-966-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG058555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: