=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043285893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES KEITH FUJISAKI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 11/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16259 SYLVESTER RD SW SUITE 501
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98166-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-243-1100
-----------------------------------------------------
Fax | 206-431-0835
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 MADISON ST SUITE 901
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-1172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-264-8100
-----------------------------------------------------
Fax | 206-264-8689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 29370
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD60174702
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------