Andrew Edward Luckey III, M.D., Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A69654 Issued in CA

Legal business name

ANDREW EDWARD LUCKEY III, M.D., INC.

Practice address

2650 Jones Way
Suite 2
Simi Valley, CA 93065-1203

Phone

(805) 577-7977

Fax

(805) 577-0745

NPI assigned

Feb 24, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrew Edward Luckey III, M.D.

Title

Owner

Phone

(805) 577-7977

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298505600000",
    "number": "1598062655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 N FAIRFAX AVE",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900464712",
            "telephone_number": "323-876-8548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 JONES WAY",
            "address_2": "SUITE 2",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651203",
            "telephone_number": "805-577-7977",
            "fax_number": "805-577-0745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW EDWARD LUCKEY III, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-24",
        "last_updated": "2011-02-24",
        "status": "A",
        "authorized_official_last_name": "LUCKEY",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-577-7977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A69654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "A69654",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rajeswari Ananda, M.D.
• Anchor and Bloom Doulas
• Anchor of Hope Recovery
• Chiconia Anderson, AMFT
• Josie Marie Anderson, LMFT
• Andrew P. Ordon, M.D., a Professional Corporation
• Ashley Andrew, IBCLC
• Maria Cristina Ang-Rodriguez
• Jani Cris Junio Angeles, PTA
• Anita Kaul MD Inc

• Surgery Physician in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.