Provider Demographics
NPI:1306495957
Name:KEVIN LEE FUJIMOTO, PYS.D., INC.
Entity type:Organization
Organization Name:KEVIN LEE FUJIMOTO, PYS.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FUJIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-262-1661
Mailing Address - Street 1:205 AVE I
Mailing Address - Street 2:SUITE 7
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 AVE I
Practice Address - Street 2:SUITE 7
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:424-262-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEVIN LEE FUJIMOTO, PYS.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty