Provider Demographics
NPI:1164429015
Name:FUJITANI, ROY MASAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:MASAMI
Last Name:FUJITANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CITY BLVD W
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2903
Mailing Address - Country:US
Mailing Address - Phone:714-456-5453
Mailing Address - Fax:714-456-6070
Practice Address - Street 1:333 CITY BLVD W
Practice Address - Street 2:SUITE 700
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2903
Practice Address - Country:US
Practice Address - Phone:714-456-5453
Practice Address - Fax:714-456-6070
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG541012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG54101OtherMEDICAL LICENSE
CAG54101OtherMEDICAL LICENSE
CAG54101OtherMEDICAL LICENSE