Healthcare Provider Details

I. General information

NPI: 1740768423
Provider Name (Legal Business Name): KEVIN YUKIO FUJIMOTO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18650 NW CORNELL RD
HILLSBORO OR
97124-9207
US

IV. Provider business mailing address

17541 SW ROSE PETAL LN
BEAVERTON OR
97003-7634
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-9760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number61892
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: