Provider Demographics
NPI:1700828779
Name:LUKE, HAROLD POHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:POHANG
Last Name:LUKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11118
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-1118
Mailing Address - Country:US
Mailing Address - Phone:909-793-0077
Mailing Address - Fax:909-793-8262
Practice Address - Street 1:137 E VINE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4759
Practice Address - Country:US
Practice Address - Phone:909-793-0077
Practice Address - Fax:909-793-8262
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42450Medicare UPIN