MEDICARE: FUMITO ITO MD PHD

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	208600000X	Surgery Physician	282373	NY
2	2086X0206X	Surgical Oncology Physician	282373	NY
3	2086X0206X	Surgical Oncology Physician	C175446	CA

General Provider Information

NPI Number	:	1386609584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FUMITO ITO MD PHD

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-442-9062
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 SAN PABLO ST STE 6200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5331
Country	:	US
Telephone Number	:	323-442-9062
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	11/22/2022

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