MEDICARE: DR. JEFFREY T FUJIMOTO D.D.S.

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	1223P0106X	Oral and Maxillofacial Pathology Dentistry	28442	CA

General Provider Information

NPI Number	:	1841381753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY T FUJIMOTO D.D.S.

Provider Business Mailing Address
First Line	:	348 TARAVAL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1953
Country	:	US
Telephone Number	:	415-564-6800
Fax Number	:	415-564-2319

Provider Business Practice Location Address
First Line	:	348 TARAVAL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1953
Country	:	US
Telephone Number	:	415-564-6800
Fax Number	:	415-564-2319

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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