Provider Demographics
NPI:1437600954
Name:LUONG, SANG VAN
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:VAN
Last Name:LUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-3323
Mailing Address - Country:US
Mailing Address - Phone:201-600-9375
Mailing Address - Fax:
Practice Address - Street 1:126 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-3323
Practice Address - Country:US
Practice Address - Phone:201-600-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator