Provider Demographics
NPI:1659826857
Name:FUSHIMI, YURIKO (LAC)
Entity Type:Individual
Prefix:
First Name:YURIKO
Middle Name:
Last Name:FUSHIMI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 E OLMSTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4642
Mailing Address - Country:US
Mailing Address - Phone:626-233-9957
Mailing Address - Fax:714-838-1114
Practice Address - Street 1:14151 NEWPORT AVE STE 102
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5174
Practice Address - Country:US
Practice Address - Phone:714-838-8931
Practice Address - Fax:714-838-1114
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist