Provider Demographics
NPI:1548593064
Name:FUKUNAGA, KARY L (KARY FUKUNAGA)
Entity Type:Individual
Prefix:
First Name:KARY
Middle Name:L
Last Name:FUKUNAGA
Suffix:
Gender:F
Credentials:KARY FUKUNAGA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12459 FALLCREEK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2076
Mailing Address - Country:US
Mailing Address - Phone:562-404-7348
Mailing Address - Fax:
Practice Address - Street 1:8300 S VERMONT AVE FL 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3422
Practice Address - Country:US
Practice Address - Phone:323-525-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program