Provider Demographics
NPI:1043285893
Name:FUJISAKI, CHARLES KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:FUJISAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 501
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-243-1100
Practice Address - Fax:206-431-0835
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO29370207XX0005X
WAMD60174702207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0270452OtherLABOR & INDUSTRIES
CO104267500OtherFEDERAL WORKMAN'S COMP
WAP00952912OtherRAILROAD MEDICARE
WA1043285893Medicaid
CO4213838OtherAETNA
WA192640139OtherUS DEPT OF LABOR - OWCP
CO900064263002OtherROCKY MOUNTAIN HMO
CO90006426301OtherPACIFICARE
CO20872771Medicaid
COFUA29319OtherBLUE CROSS BLUE SHIELD
COP00049979OtherRAIL ROAD MEDICARE
WAAB8895133Medicare PIN
WA0270452OtherLABOR & INDUSTRIES
COFUA29319OtherBLUE CROSS BLUE SHIELD
CO4213838OtherAETNA