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Organization
SACHIKO FUKUMAN, DDS INC
Active
Organization
SACHIKO FUKUMAN, DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SACHIKO VIRGINIA FUKUMAN DDS (OWNER)
(949) 248-7772
Entity
Organization
Contact information
Practice address
653 CAMINO DE LOS MARES, SU. 113, SAN CLEMENTE, CA 92673-2808
(949) 248-7772
(949) 248-0516
Mailing address
653 CAMINO DE LOS MARES, SU. 113, SAN CLEMENTE, CA 92673-2808
(949) 248-7772
(949) 248-0516
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
28554
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
652268
UNITED CONCORDIA PROVIDER
CA
Enumeration date
03/06/2007
Last updated
08/22/2020
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