Provider Demographics
NPI:1376756452
Name:W EDWARD LOUKA,MD,INC.
Entity Type:Organization
Organization Name:W EDWARD LOUKA,MD,INC.
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGEEH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-303-2525
Mailing Address - Street 1:931 BUENA VISTA ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1712
Mailing Address - Country:US
Mailing Address - Phone:626-303-2525
Mailing Address - Fax:626-303-7664
Practice Address - Street 1:931 BUENA VISTA ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1712
Practice Address - Country:US
Practice Address - Phone:626-303-2525
Practice Address - Fax:626-303-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C378300Medicaid
CA00C378300Medicaid
CAE10306Medicare UPIN