Provider Demographics
NPI:1922289503
Name:ST. LUKE UNIVERSITY
Entity Type:Organization
Organization Name:ST. LUKE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-623-0302
Mailing Address - Street 1:1460 E HOLT AVE
Mailing Address - Street 2:SUITE 72
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5856
Mailing Address - Country:US
Mailing Address - Phone:909-623-0302
Mailing Address - Fax:909-623-0480
Practice Address - Street 1:1460 E HOLT AVE
Practice Address - Street 2:SUITE 72
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5856
Practice Address - Country:US
Practice Address - Phone:909-623-0302
Practice Address - Fax:909-623-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5732171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty