Provider Demographics
NPI:1487644613
Name:FUKUNAGA, KARL KEN (MD)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:KEN
Last Name:FUKUNAGA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4763
Mailing Address - Country:US
Mailing Address - Phone:310-375-1246
Mailing Address - Fax:310-375-0590
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:SUITE 290
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4763
Practice Address - Country:US
Practice Address - Phone:310-375-1246
Practice Address - Fax:310-375-0590
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG72161207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31651Medicare UPIN