1033173760 NPI number — KENNETH H LUK MD

Table of content: DR. VICKI P MOORE D.O. (NPI 1023280039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033173760 NPI number — KENNETH H LUK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUK
Provider First Name:
KENNETH
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1033173760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1760 E RIVER RD
Provider Second Line Business Mailing Address:
STE. # 350
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-5877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-519-7775
Provider Business Mailing Address Fax Number:
520-519-7910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1916 W BETHANY HOME RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85015-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-283-7979
Provider Business Practice Location Address Fax Number:
602-864-5031
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  20777 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 268921 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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