Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A128044 | CA |
NPI | 1124443122 |
---|---|
Provider Name | Dr. Luke Mckee Wiggins |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2014 |
Last Update Date | 14/09/2020 |