Provider Demographics
NPI:1598874778
Name:LUONG, JACQUELINE A (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:A
Last Name:LUONG
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2120
Mailing Address - Country:US
Mailing Address - Phone:952-920-2600
Mailing Address - Fax:952-920-2668
Practice Address - Street 1:6545 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2120
Practice Address - Country:US
Practice Address - Phone:952-920-2600
Practice Address - Fax:952-920-2668
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40310208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00263371OtherRAILROAD MEDICARE
MN40310OtherMINNESOTA LICENSE
MN151727OtherUCARE
MN495527700Medicaid
MN548T8LUOtherBLUE CROSS BLUE SHIELD
MN1300021OtherMEDICA PRIMARY
WI34612600Medicaid
MN960001031243OtherPREFERREDONE
MN1300179OtherMEDICA
MNHP35943OtherHEALTHPARTNERS
MN40310OtherMINNESOTA LICENSE
MNH13229Medicare UPIN