Provider Demographics
NPI:1417046491
Name:FUJISAKI, CRAIG K (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:K
Last Name:FUJISAKI
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 1:4509 TALBOT RD S STE 200
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6294
Mailing Address - Country:US
Mailing Address - Phone:425-228-4520
Mailing Address - Fax:425-226-0283
Practice Address - Street 1:4509 TALBOT RD S STE 200
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6294
Practice Address - Country:US
Practice Address - Phone:425-228-4520
Practice Address - Fax:425-226-0283
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017792207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAFU5460OtherREGENCE BLUE SHIELD
WAFU5460OtherREGENCE BLUE SHIELD