Provider Demographics
NPI:1154409001
Name:FUKS, ALEKSEY (DDS)
Entity type:Individual
Prefix:MR
First Name:ALEKSEY
Middle Name:
Last Name:FUKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5967
Mailing Address - Country:US
Mailing Address - Phone:323-650-1001
Mailing Address - Fax:323-650-1633
Practice Address - Street 1:8205 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5967
Practice Address - Country:US
Practice Address - Phone:323-650-1001
Practice Address - Fax:323-650-1633
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94070Medicaid
CAG89900Medicaid