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NPI Code Detail

MEDICARE: DJIAN-LUKE TY

MEDICARE: DJIAN-LUKE TY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1558210641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DJIAN-LUKE TY
Provider Business Mailing Address
First Line : 1856 JUPITER HILLS RD
Second Line :
City : CORONA
State : CA
Zip : 92883-0660
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1800 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2386
Country : US
Telephone Number : 702-774-5134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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Directions to “ DJIAN-LUKE TY ” Practice Location

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