Provider Demographics
NPI:1972773257
Name:FUKUSHIMA, JANICE Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:Y
Last Name:FUKUSHIMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23520 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5203
Mailing Address - Country:US
Mailing Address - Phone:310-539-7835
Mailing Address - Fax:
Practice Address - Street 1:23520 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5203
Practice Address - Country:US
Practice Address - Phone:310-539-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice