Healthcare Provider Details

I. General information

NPI: 1063597961
Provider Name (Legal Business Name): JONATHAN LEE HULKOWER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S MEDFORD DR
LUFKIN TX
75901-6260
US

IV. Provider business mailing address

9007 SAWYER ST
LOS ANGELES CA
90035-4140
US

V. Phone/Fax

Practice location:
  • Phone: 936-639-1141
  • Fax:
Mailing address:
  • Phone: 310-838-3902
  • Fax: 323-653-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70818
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM-15281
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number183156
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberG80603
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberQ0938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: