Provider Demographics
NPI:1871789594
Name:FUKUTA, YURIKO (MD)
Entity type:Individual
Prefix:
First Name:YURIKO
Middle Name:
Last Name:FUKUTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YURIKO
Other - Middle Name:
Other - Last Name:KONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:50 MEDICAL PARK
Mailing Address - Street 2:SUITE 704
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6449
Mailing Address - Country:US
Mailing Address - Phone:304-234-1919
Mailing Address - Fax:304-234-1918
Practice Address - Street 1:7200 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0881207R00000X, 207RI0200X
OH120332207RI0200X
WV24901207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine