Provider Demographics
NPI:1023018009
Name:LUECHA, ANGSUMARN (MD)
Entity Type:Individual
Prefix:
First Name:ANGSUMARN
Middle Name:
Last Name:LUECHA
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 1:4300 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:714-528-4211
Mailing Address - Fax:714-579-6868
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-528-4211
Practice Address - Fax:714-579-6868
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI20713Medicare UPIN
CAWA81197AMedicare PIN