1275723637 NPI number — DR. JASON LUK D.P.T.

Table of content: DR. JASON LUK D.P.T. (NPI 1275723637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275723637 NPI number — DR. JASON LUK D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUK
Provider First Name:
JASON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
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:
1275723637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
435 ARDEN AVE
Provider Second Line Business Mailing Address:
#370
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-240-5012
Provider Business Mailing Address Fax Number:
818-240-8438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 ARDEN AVE
Provider Second Line Business Practice Location Address:
#370
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91203-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-240-5012
Provider Business Practice Location Address Fax Number:
818-240-8438
Provider Enumeration Date:
07/31/2007

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: 225100000X , with the licence number:  33781 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 056807 . This is a "MUTUAL OF OMAHA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PT6698A . This is a "MEDICARE NHIC PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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