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NPI Code Detail

MEDICARE: JONATHAN LEE HULKOWER M.D.

MEDICARE: JONATHAN LEE HULKOWER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician70818GA
22084P0800XPsychiatry PhysicianM-15281ID
32084P0800XPsychiatry Physician183156NY
4282N00000XGeneral Acute Care HospitalG80603CA
52084P0800XPsychiatry PhysicianQ0938TX

General Provider Information

NPI Number : 1063597961
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN LEE HULKOWER M.D.
Provider Business Mailing Address
First Line : 9007 SAWYER ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035-4140
Country : US
Telephone Number : 310-838-3902
Fax Number : 323-653-2786
Provider Business Practice Location Address
First Line : 2001 S MEDFORD DR
Second Line :
City : LUFKIN
State : TX
Zip : 75901-6260
Country : US
Telephone Number : 936-639-1141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/23/2025

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