Basic Information
| Provider Information | |||||||||
| NPI: | 1598428518 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OUK | ||||||||
| FirstName: | LIDIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5002 S MILL AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852826828 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 5002 S MILL AVE | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852826828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022776211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2021 | ||||||||
| LastUpdateDate: | 12/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 8769 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.