Provider Demographics
NPI:1174547814
Name:FUKUTAKI, KAREN V (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:V
Last Name:FUKUTAKI
Suffix:
Gender:F
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:PO BOX 460541
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-0541
Mailing Address - Country:US
Mailing Address - Phone:303-667-3249
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:5121 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2656
Practice Address - Country:US
Practice Address - Phone:130-366-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO268422084P0800X
AZ506522084P0800X
CAG1472272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111271Medicaid
CO01268424Medicaid
CO260048251OtherRAILROAD MEDICARE
CO260048251OtherRAILROAD MEDICARE
COD11485Medicare ID - Type Unspecified