Provider Demographics
NPI:1093184673
Name:FUKUI, ALICE REINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:REINA
Last Name:FUKUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 LOMITA BLVD
Mailing Address - Street 2:STE. 304
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3931
Mailing Address - Country:US
Mailing Address - Phone:714-360-8612
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:STE. 304
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:714-360-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice