Basic Information
Provider Information
NPI: 1952051708
EntityType: 2
ReplacementNPI:  
OrganizationName: FUKUI MEDICAL PLLC
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Mailing Information
Address1: 12645 MEMORIAL DR
Address2: STE F1 #511
City: HOUSTON
State: TX
PostalCode: 77024
CountryCode: US
TelephoneNumber: 8323770208
FaxNumber:  
Practice Location
Address1: 13428 BISSONNET ST
Address2:  
City: HOUSTON
State: TX
PostalCode: 770836275
CountryCode: US
TelephoneNumber: 7133514300
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2022
LastUpdateDate: 03/25/2022
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AuthorizedOfficialLastName: FUKUI
AuthorizedOfficialFirstName: RIYA
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AuthorizedOfficialTitleorPosition: MEMBER
AuthorizedOfficialTelephone: 7133630913
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 03/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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