Provider Demographics
NPI:1437526928
Name:LUONG, LONGKIM
Entity Type:Individual
Prefix:
First Name:LONGKIM
Middle Name:
Last Name:LUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N MAGNOLIA AVE
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3113
Mailing Address - Country:US
Mailing Address - Phone:714-204-9731
Mailing Address - Fax:
Practice Address - Street 1:916 N MAGNOLIA AVE
Practice Address - Street 2:APT/SUITE
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3113
Practice Address - Country:US
Practice Address - Phone:714-204-9731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3200224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant