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General NPI Number Information
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NPI Number | 1821978164
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Entity Type | Individual
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Provider Name | YUICHI FUKADA LMT
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Gender | Male
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1750 SW SKYLINE BLVD STE 100
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City | PORTLAND
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State | OR
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Zip | 97221-2536
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Country | US
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Telephone | 503-754-8902
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Fax |
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Provider Business Mailing Address
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Address Line | 10559 SW TIGARD ST APT 55
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City | TIGARD
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State | OR
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Zip | 97223-4148
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Country | US
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Telephone | 503-754-8902
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 16601
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License Number State | OR
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