Provider Demographics
NPI:1871072587
Name:FUSU, ANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:
Last Name:FUSU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16218 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3013
Mailing Address - Country:US
Mailing Address - Phone:206-244-5187
Mailing Address - Fax:206-248-5292
Practice Address - Street 1:16218 42ND AVE S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3013
Practice Address - Country:US
Practice Address - Phone:206-244-5187
Practice Address - Fax:206-248-5292
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608626121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice