Healthcare Provider Details

I. General information

NPI: 1275795965
Provider Name (Legal Business Name): TADAO FUJIWARA, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 WHITTIER BLVD
LOS ANGELES CA
90022
US

IV. Provider business mailing address

5300 WHITTIER BLVD
LOS ANGELES CA
90022-4015
US

V. Phone/Fax

Practice location:
  • Phone: 323-980-8488
  • Fax: 323-980-4848
Mailing address:
  • Phone: 323-980-8488
  • Fax: 323-980-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA25666
License Number StateCA

VIII. Authorized Official

Name: LILY FUJIWARA
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-980-8488