Provider Demographics
NPI:1699210898
Name:FUSE, JUNKO
Entity Type:Individual
Prefix:
First Name:JUNKO
Middle Name:
Last Name:FUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:
Other - Last Name:FUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:5404 WALNUT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5404 WALNUT AVE STE B
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2517
Practice Address - Country:US
Practice Address - Phone:949-654-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist