Provider Demographics
NPI:1720001977
Name:LUMKONG, GERARD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:ANTHONY
Last Name:LUMKONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-479-3900
Mailing Address - Fax:760-753-8177
Practice Address - Street 1:477 N EL CAMINO REAL STE A208
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1329
Practice Address - Country:US
Practice Address - Phone:760-479-3900
Practice Address - Fax:760-753-8175
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G800360Medicaid
CA00G800360Medicaid
CAWA80036AMedicare ID - Type Unspecified