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General NPI Number Information
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NPI Number | 1982161113
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Entity Type | Organization
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Legal Business Name | ST. LUKE MEDICAL ARTS INC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 1740 W GARDENA BLVD
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City | GARDENA
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State | CA
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Zip | 90247-4764
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Country | US
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Telephone | 424-551-3110
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Fax | 844-272-8062
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Provider Business Mailing Address
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Address Line | 1740 W GARDENA BLVD
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City | GARDENA
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State | CA
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Zip | 90247-4764
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Country | US
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Telephone | 424-551-3110
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Fax | 844-272-8062
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Authorized Official
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Title or Position | M.D. / PRESIDENT
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Name | DR. DONGJIN SUNG
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Credential | M.D.
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Telephone | 716-868-9146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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