Lucas De Jong
Family Medicine in Wichita, KS. Individual provider (NPI-1).
NPI number1164090528
StatusActive
Last updated in NPPESJun 14, 2021
Details
- NPI
- 1164090528
- Entity type
- Individual (NPI-1)
- Name
- Lucas De Jong
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 14, 2021
- Certification date
- Jun 14, 2021
- Last updated
- Jun 14, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 94-10748 | KS | Yes |
Practice location
1010 N Kansas StWichita, KS 67214-3124
Phone 316-293-2665
Mailing address
1010 N Kansas StWichita, KS 67214-3124
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