Provider Demographics
NPI:1275795965
Name:TADAO FUJIWARA, M.D. INC.
Entity Type:Organization
Organization Name:TADAO FUJIWARA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUJIWARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-980-8488
Mailing Address - Street 1:5300 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4015
Mailing Address - Country:US
Mailing Address - Phone:323-980-8488
Mailing Address - Fax:323-980-4848
Practice Address - Street 1:5300 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-980-8488
Practice Address - Fax:323-980-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25666207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A25666Medicaid
CA0A25666Medicaid
CAA24525Medicare UPIN
CAW3856Medicare PIN