=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710894787
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE FUJISAWA RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2026
-----------------------------------------------------
Last Update Date | 08/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2111 EXCHANGE ST
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97103-3329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-980-9298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35551 LITTLE LN
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97103-8331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WH1000X
-----------------------------------------------------
Taxonomy Name | Hospice Registered Nurse
-----------------------------------------------------
License Number | 10005665
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------