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General NPI Number Information
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NPI Number | 1679736268
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Entity Type | Organization
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Legal Business Name | LUK BHAVA MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 880 S ATLANTIC BLVD SUITE 307
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City | MONTEREY PARK
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State | CA
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Zip | 91754-4700
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Country | US
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Telephone | 626-300-8424
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Fax |
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Provider Business Mailing Address
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Address Line | 880 S ATLANTIC BLVD SUITE 307
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City | MONTEREY PARK
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State | CA
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Zip | 91754-4700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LUKCHAI BHAVABHUTANON
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Credential | D.O.
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Telephone | 626-300-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20A7134
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License Number State | CA
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