Provider Demographics
NPI:1700382157
Name:FUKUI, RIYA
Entity Type:Individual
Prefix:
First Name:RIYA
Middle Name:
Last Name:FUKUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-747-9655
Mailing Address - Fax:281-724-1857
Practice Address - Street 1:500 N KOBAYASHI STE A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4722
Practice Address - Country:US
Practice Address - Phone:281-747-9655
Practice Address - Fax:281-724-1857
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4160208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program