Provider Demographics
NPI:1396816849
Name:LUONG, DORRIS DAO (NP)
Entity Type:Individual
Prefix:MS
First Name:DORRIS
Middle Name:DAO
Last Name:LUONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DORRIS
Other - Middle Name:DAO
Other - Last Name:LUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1150 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2037
Mailing Address - Country:US
Mailing Address - Phone:650-299-2840
Mailing Address - Fax:
Practice Address - Street 1:1150 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2037
Practice Address - Country:US
Practice Address - Phone:650-299-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ63445Medicare UPIN