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General NPI Number Information
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NPI Number | 1225137391
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Entity Type | Individual
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Provider Name | KENNETH YOICHI FUJIMOTO DMD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 1300 N POTRERO GRANDE DR SUITE C
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City | SOUTH SAN GABRIEL
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State | CA
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Zip | 91770-4154
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Country | US
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Telephone | 626-288-1139
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Fax | 626-288-1139
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Provider Business Mailing Address
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Address Line | 1300 N POTRERO GRANDE DR #C
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City | SOUTH SAN GABRIEL
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State | CA
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Zip | 91770
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Country | US
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Telephone | 626-288-1139
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Fax | 626-288-1139
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30758
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License Number State | CA
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