Provider Demographics
NPI:1790084408
Name:FUKUI, JAMI (MD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:FUKUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ILALO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5516
Mailing Address - Country:US
Mailing Address - Phone:808-586-5854
Mailing Address - Fax:808-586-5857
Practice Address - Street 1:1907 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1301
Practice Address - Country:US
Practice Address - Phone:808-949-3444
Practice Address - Fax:808-949-7808
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267618207R00000X
390200000X
HI19314207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program