Healthcare Provider Details

I. General information

NPI: 1497702559
Provider Name (Legal Business Name): ILAN JEFFREY ZUK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 LAMAR ST
SPRING VALLEY CA
91977-2518
US

IV. Provider business mailing address

PO BOX 18228
IRVINE CA
92623-8228
US

V. Phone/Fax

Practice location:
  • Phone: 619-722-0014
  • Fax: 619-327-4174
Mailing address:
  • Phone: 619-722-0014
  • Fax: 619-327-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: