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General NPI Number Information
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NPI Number | 1205030111
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Entity Type | Individual
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Provider Name | DOREEN LANAE FUKUSHIMA MD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 180 W BULLARD AVE STE 104
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City | CLOVIS
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State | CA
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Zip | 93612-0998
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Country | US
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Telephone | 559-203-3775
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Fax | 559-326-0607
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Provider Business Mailing Address
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Address Line | 98-1813 HAPAKI ST
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City | AIEA
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State | HI
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Zip | 96701-1633
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Country | US
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Telephone | 209-629-7490
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Fax | 351-200-8379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A124200
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDR5045
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License Number State | HI
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