Provider Demographics
NPI:1619964038
Name:JAN S LUKAC MD INC
Entity Type:Organization
Organization Name:JAN S LUKAC MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUKAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-529-9563
Mailing Address - Street 1:380 W CENTRAL AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3014
Mailing Address - Country:US
Mailing Address - Phone:714-529-9563
Mailing Address - Fax:714-529-8476
Practice Address - Street 1:380 W CENTRAL AVE
Practice Address - Street 2:STE 300
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3014
Practice Address - Country:US
Practice Address - Phone:714-529-9563
Practice Address - Fax:714-529-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32888207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA180001142OtherRAILROAD MEDICARE
CA00A328880Medicaid
CA00A328880Medicaid
A21960Medicare UPIN