Provider Demographics
NPI:1043964232
Name:LUONG, PHOEBE NHI (OD)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:NHI
Last Name:LUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TIDEWATER CV
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1661
Mailing Address - Country:US
Mailing Address - Phone:626-213-7659
Mailing Address - Fax:
Practice Address - Street 1:9515 W CAMELBACK RD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1365
Practice Address - Country:US
Practice Address - Phone:623-937-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34833152W00000X
AZ002539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist