Provider Demographics
NPI:1144625823
Name:WON, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:WON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 215TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1238
Mailing Address - Country:US
Mailing Address - Phone:510-502-6046
Mailing Address - Fax:
Practice Address - Street 1:520 N MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4623
Practice Address - Country:US
Practice Address - Phone:714-352-5800
Practice Address - Fax:714-352-5801
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5409213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery