Provider Demographics
NPI:1417330432
Name:TACHUK, EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:TACHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 ROSECRANS ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3126
Mailing Address - Country:US
Mailing Address - Phone:619-222-5433
Mailing Address - Fax:
Practice Address - Street 1:3740 ROSECRANS ST STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3126
Practice Address - Country:US
Practice Address - Phone:619-222-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA036884207N00000X, 207QB0002X, 208200000X, 208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine