Provider Demographics
NPI:1396701850
Name:FUKUDA, WILLIAM PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:FUKUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-3551
Mailing Address - Fax:949-718-6742
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 608
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-3551
Practice Address - Fax:949-718-6742
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66117207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84377Medicare UPIN
CAWA66117AMedicare ID - Type Unspecified