Provider Demographics
NPI:1841211984
Name:LEELALUCKANAKUL-TRAN, SAOWALUCK (DO)
Entity Type:Individual
Prefix:
First Name:SAOWALUCK
Middle Name:
Last Name:LEELALUCKANAKUL-TRAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAOWALUCK
Other - Middle Name:
Other - Last Name:LEELALUCKANAKUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:18601 PARK GLEN LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6810
Mailing Address - Country:US
Mailing Address - Phone:714-369-7964
Mailing Address - Fax:
Practice Address - Street 1:6000 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4232
Practice Address - Country:US
Practice Address - Phone:323-254-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics