Provider Demographics
NPI:1275723637
Name:LUK, JASON (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:LUK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 ARDEN AVE
Mailing Address - Street 2:#370
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1130
Mailing Address - Country:US
Mailing Address - Phone:818-240-5012
Mailing Address - Fax:818-240-8438
Practice Address - Street 1:435 ARDEN AVE
Practice Address - Street 2:#370
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1130
Practice Address - Country:US
Practice Address - Phone:818-240-5012
Practice Address - Fax:818-240-8438
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056807OtherMUTUAL OF OMAHA PIN
CAPT6698AOtherMEDICARE NHIC PIN