Provider Demographics
NPI:1558687798
Name:LUONG, PAUL NHAN-CHINH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NHAN-CHINH
Last Name:LUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NHAN
Other - Middle Name:CHINH
Other - Last Name:LUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2023 WESTPORT ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7970
Mailing Address - Country:US
Mailing Address - Phone:209-665-4163
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-323-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109848390200000X, 207RH0002X
NY257761390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program