Healthcare Provider Details

I. General information

NPI: 1538970603
Provider Name (Legal Business Name): FARAH JUKAKU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 SKYPARK DR STE 302
TORRANCE CA
90505-5388
US

IV. Provider business mailing address

2790 SKYPARK DR STE 302
TORRANCE CA
90505-5388
US

V. Phone/Fax

Practice location:
  • Phone: 424-216-6110
  • Fax:
Mailing address:
  • Phone: 424-216-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW136120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: