Provider Demographics
NPI:1699759266
Name:VUKOV, JUDITH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:VUKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10578
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-3578
Mailing Address - Country:US
Mailing Address - Phone:818-956-3207
Mailing Address - Fax:
Practice Address - Street 1:121 W LEXINGTON DR
Practice Address - Street 2:STE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2203
Practice Address - Country:US
Practice Address - Phone:818-956-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0380362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38036Medicare PIN