Provider Demographics
NPI:1235327990
Name:LUONG, HIEN D (DC)
Entity Type:Individual
Prefix:DR
First Name:HIEN
Middle Name:D
Last Name:LUONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 38TH AVE SPC 21
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3203
Mailing Address - Country:US
Mailing Address - Phone:831-462-1747
Mailing Address - Fax:
Practice Address - Street 1:1255 38TH AVE SPC 21
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-3203
Practice Address - Country:US
Practice Address - Phone:831-462-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0268980Medicare PIN