Healthcare Provider Details

I. General information

NPI: 1144989807
Provider Name (Legal Business Name): KATHRYN FUKUMOTO WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN DYAN FUKUMOTO

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 OWENS DR. BUILDING E, 2ND FLOOR
PLEASANTON CA
94588-3900
US

IV. Provider business mailing address

5820 OWENS DR. BUILDING E, 2ND FLOOR
PLEASANTON CA
94588-3900
US

V. Phone/Fax

Practice location:
  • Phone: 925-737-3785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: