Healthcare Provider Details

I. General information

NPI: 1538201249
Provider Name (Legal Business Name): LOUIS LOUK JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

10189 PINECASTLE ST
SAN DIEGO CA
92131-2291
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7929
  • Fax: 619-532-7912
Mailing address:
  • Phone: 619-532-7929
  • Fax: 619-532-7912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO1918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: