Provider Demographics
NPI:1104951979
Name:RUKAN DACCAK, MD, PA
Entity type:Organization
Organization Name:RUKAN DACCAK, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DACCAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-910-7779
Mailing Address - Street 1:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-0405
Mailing Address - Country:US
Mailing Address - Phone:713-910-7779
Mailing Address - Fax:713-910-7760
Practice Address - Street 1:4450 E SAM HOUSTON PKWY S STE H2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3950
Practice Address - Country:US
Practice Address - Phone:713-910-7779
Practice Address - Fax:713-910-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096904002Medicaid
TX096904002Medicaid
TX00408TMedicare PIN