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General NPI Number Information
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NPI Number | 1477545556
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Entity Type | Organization
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Legal Business Name | JOANNA TUKAJ, M.D., INC.
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 130 W ROUTE 66 STE324
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City | GLENDORA
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State | CA
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Zip | 91740-6252
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Country | US
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Telephone | 626-914-0017
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Fax | 626-914-0288
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Provider Business Mailing Address
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Address Line | 130 W ROUTE 66 STE324
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City | GLENDORA
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State | CA
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Zip | 91740-6252
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Country | US
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Telephone | 626-914-0017
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Fax | 626-914-0288
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Authorized Official
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Title or Position | SECRETARY/BUS.OFC.MGR
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Name | MR. KRZYSZTOF TUKAJ
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Credential |
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Telephone | 909-394-0828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A051499
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License Number State | CA
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