Provider Demographics
NPI:1508821919
Name:MALEK, LUKE FAWZI SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:FAWZI
Last Name:MALEK
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ABDELMALEK
Other - Middle Name:FAWZI
Other - Last Name:ABDELMALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3929 W ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:310-644-4648
Mailing Address - Fax:310-644-0503
Practice Address - Street 1:3929 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250
Practice Address - Country:US
Practice Address - Phone:310-644-4648
Practice Address - Fax:310-644-0503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist