Kyle T Fukano, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00008801 Issued in WA

Practice address

1684 Main St
Suite 4
Freeland, WA 98249

Phone

(360) 331-5211

Fax

(360) 331-5212

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kyle Fukano DDS PLLC

  • General Practice Dentistry
  • Forks, WA
  • NPI 1508230038
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450828800000",
    "number": "1407951973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 729",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982490729",
            "telephone_number": "360-331-5211",
            "fax_number": "360-331-5212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 MAIN ST",
            "address_2": "SUITE 4",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "98249",
            "telephone_number": "360-331-5211",
            "fax_number": "360-331-5212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUKANO",
        "first_name": "KYLE",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2015-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DDS LICENSE",
            "identifier": "DE00008801",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fragrant Hills
• Freeland Clinic Inc
• Freeland Family Medical Center, PC
• Freeland Medical Center Inc
• Freeland Primary Care PLLC
• Alicia Ann Gonzalez, ND
• Michael James Goodman, M.P.T.
• David C Goodwin, D.D.S.
• Ilana Grace, LMP
• Sheryll Lynne Gregory, LMP

• All providers in Freeland, WA
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.