Provider Demographics
NPI:1013014919
Name:FUKUJI, RANDALL (PT)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:FUKUJI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ULUNIU ST STE 301
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2544
Mailing Address - Country:US
Mailing Address - Phone:808-261-4321
Mailing Address - Fax:808-261-4320
Practice Address - Street 1:1834 NUUANU AVE STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2427
Practice Address - Country:US
Practice Address - Phone:808-521-4922
Practice Address - Fax:808-521-4921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002223Medicaid
HI002223Medicaid