Provider Demographics
NPI:1699954644
Name:LUKAC, JAN S (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:S
Last Name:LUKAC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 W CENTRAL AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:714-529-9563
Mailing Address - Fax:714-529-8476
Practice Address - Street 1:380 WEST CENTRAL AVE
Practice Address - Street 2:STE 300
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-529-9563
Practice Address - Fax:714-529-8476
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2019-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA32888207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180001142OtherRAILROAD MEDICARE
CA180001142OtherRAILROAD MEDICARE NUMBER
CA00A328880Medicaid
CA00A328880Medicaid
CAWA32888BMedicare PIN