Miki Sadie Fukusumi

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

26238 Issued in CA

Practice address

11840 S la Cienega Blvd
Hawthorne, CA 90250-3459

Phone

(424) 269-3400

Fax

(310) 882-5451

NPI assigned

Jul 12, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Napa Center, Inc.

  • Rehabilitation Clinic/Center
  • Hawthorne, CA
  • NPI 1194961433

  Speech-Language Pathologist

  NPD (past)

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1821439381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11840 S LA CIENEGA BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902503459",
            "telephone_number": "424-269-3400",
            "fax_number": "310-882-5451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11840 S LA CIENEGA BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902503459",
            "telephone_number": "424-269-3400",
            "fax_number": "310-882-5451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "621 Acolito Pl",
            "address_purpose": "LOCATION",
            "city": "Diamond Bar",
            "state": "CA",
            "postal_code": "917651303",
            "country_code": "US",
            "telephone_number": "909-969-4992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUKUSUMI",
        "first_name": "MIKI",
        "middle_name": "SADIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-12",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "26238",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Folkman, PA-C
• Fonthill Gardens Inc
• For Eyes Optical of California, Inc
• Fox Hills Pharmacy Inc (Grand Avenue Pharmacies)
• Fratt Dental Corporation (Castle Dental Centers-Hawthorne)
• Albert Fuller III
• James Gabelich, PHARMD
• Gabes Medical Supply
• Danielle Gagain
• Maria Galang, DDS

• Speech-Language Pathologist in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.