Provider Demographics
NPI:1336407923
Name:TUKAJ, JOANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:TUKAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:TUKAJ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOANNA TUKAJ MD INC
Mailing Address - Street 1:1433 N HOLLENBECK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-1558
Mailing Address - Country:US
Mailing Address - Phone:626-914-0017
Mailing Address - Fax:626-914-0288
Practice Address - Street 1:1433 N HOLLENBECK AVE STE 104
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1558
Practice Address - Country:US
Practice Address - Phone:626-914-0017
Practice Address - Fax:606-914-0288
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A051499Medicaid
CA1932146370OtherMAYFLOWER MG NPPES, TYPE-2 NPI
CA22-3922241Medicaid
CA1336407923OtherNPPES, TYPE-1 NPI
CA1477545556OtherNPPES, TYPE-2 NPI
CA95-4831794Medicaid