1295286383 NPI number — LUEKENGA WAY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295286383 NPI number — LUEKENGA WAY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUEKENGA WAY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295286383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 MEDICAL DR
Provider Second Line Business Mailing Address:
202-A
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-4946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-298-4327
Provider Business Mailing Address Fax Number:
801-298-4328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 MEDICAL DR
Provider Second Line Business Practice Location Address:
202A
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-298-4327
Provider Business Practice Location Address Fax Number:
801-298-4328
Provider Enumeration Date:
10/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LUEKENGA
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DOCTOR OF AUDIOLOGY/OWNER
Authorized Official Telephone Number:
801-298-4327

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  80296474101 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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