Provider Demographics
NPI:1154839645
Name:LUONG, TONG MINH (MSN)
Entity Type:Individual
Prefix:MR
First Name:TONG
Middle Name:MINH
Last Name:LUONG
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E VALLEY BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3196
Mailing Address - Country:US
Mailing Address - Phone:626-581-1000
Mailing Address - Fax:626-581-1007
Practice Address - Street 1:2707 E VALLEY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792
Practice Address - Country:US
Practice Address - Phone:626-581-1000
Practice Address - Fax:626-581-1007
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner