Provider Demographics
NPI:1689049587
Name:LUU, CUONG
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:
Last Name:LUU
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, BCBA-D
Mailing Address - Street 1:1600 POTRERO GRANDE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4167
Mailing Address - Country:US
Mailing Address - Phone:626-927-6341
Mailing Address - Fax:
Practice Address - Street 1:1600 POTRERO GRANDE DR STE 7
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770
Practice Address - Country:US
Practice Address - Phone:626-927-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-06-2834103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst