Active NPI
John Tsukuru Fukuda
- General Practice Dentistry
- Nederland, TX
National Provider Identifier
1598772386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 16264
- Practice address
- 1435 S Hwy 69
Nederland, TX 77627 - Phone
- (409) 722-1496
- Fax
- (409) 722-1413
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 16264 | TX | Primary |
Addresses
Primary practice location
1435 S Hwy 69
Nederland, TX 77627
Mailing address
1435 S Highway 69
Nederland, TX 77627
Phone (409) 722-1496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 12, 2016 through Apr 12, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16264 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292544000000",
"number": "1598772386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1435 S HIGHWAY 69",
"city": "NEDERLAND",
"state": "TX",
"postal_code": "77627",
"telephone_number": "409-722-1496",
"fax_number": "409-722-1413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1435 S HWY 69",
"city": "NEDERLAND",
"state": "TX",
"postal_code": "77627",
"telephone_number": "409-722-1496",
"fax_number": "409-722-1413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUKUDA",
"first_name": "JOHN",
"middle_name": "TSUKURU",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2010-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "16264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nederland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.