Provider Demographics
NPI:1700064409
Name:JUDITH VUKOV, M.D.,INC.
Entity type:Organization
Organization Name:JUDITH VUKOV, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VUKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1818-956-3207
Mailing Address - Street 1:PO BOX 10578
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-3578
Mailing Address - Country:US
Mailing Address - Phone:818-956-3207
Mailing Address - Fax:818-956-1180
Practice Address - Street 1:121 W LEXINGTON DR
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2203
Practice Address - Country:US
Practice Address - Phone:818-956-3207
Practice Address - Fax:818-956-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA380362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A380360Medicaid
CAA85092Medicare UPIN
CA00A380360Medicaid