Provider Demographics
NPI:1679608715
Name:FUJITA, ANDREW KNOLL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KNOLL
Last Name:FUJITA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13942 GIORDANO ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-2155
Mailing Address - Country:US
Mailing Address - Phone:626-332-7080
Mailing Address - Fax:626-332-7071
Practice Address - Street 1:855 N LARK ELLEN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1099
Practice Address - Country:US
Practice Address - Phone:626-332-7080
Practice Address - Fax:626-332-7071
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82913Medicare UPIN