Healthcare Provider Details

I. General information

NPI: 1336407923
Provider Name (Legal Business Name): JOANNA TUKAJ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA TUKAJ JOANNA TUKAJ MD INC

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N HOLLENBECK AVE STE 104
COVINA CA
91722-1558
US

IV. Provider business mailing address

1433 N HOLLENBECK AVE STE 104
COVINA CA
91722-1558
US

V. Phone/Fax

Practice location:
  • Phone: 626-914-0017
  • Fax: 606-914-0288
Mailing address:
  • Phone: 626-914-0017
  • Fax: 626-914-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: