MEDICARE: KELL FUJIMOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	19682	CA

General Provider Information

NPI Number	:	1306243530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELL FUJIMOTO

Provider Business Mailing Address
First Line	:	2845 MOORPARK AVE
Second Line	:	SUITE 203
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3158
Country	:	US
Telephone Number	:	408-622-9302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 MOORPARK AVE
Second Line	:	SUITE 203
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3158
Country	:	US
Telephone Number	:	408-622-9302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	12/03/2014

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