Active NPI
Derrin Yoshio Kilipaki Fukuda, PSY.D.
- Clinical Child & Adolescent Psychologist
- Portland, OR
National Provider Identifier
1962781542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 2399
- Practice address
- 516 SE Morrison St Ste 400
Portland, OR 97214-2344 - Phone
- (971) 242-8894
- NPI assigned
- Aug 12, 2011
- 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 |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 2399 | OR | Primary |
Addresses
Primary practice location
516 SE Morrison St Ste 400
Portland, OR 97214-2344
Mailing address
516 SE Morrison St Ste 400
Portland, OR 97214-2344
Phone (971) 242-8894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2399 | OR | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475193600000",
"number": "1962781542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "516 SE MORRISON ST STE 400",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972142344",
"telephone_number": "971-242-8894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 SE MORRISON ST STE 400",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972142344",
"telephone_number": "971-242-8894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUKUDA",
"first_name": "DERRIN",
"middle_name": "YOSHIO KILIPAKI",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-12",
"last_updated": "2016-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "2399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.