Provider Demographics
NPI:1720370729
Name:FONG-LUNA, KAREN JUSTINE
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:JUSTINE
Last Name:FONG-LUNA
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 1:4801 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-4849
Mailing Address - Country:US
Mailing Address - Phone:916-737-9202
Mailing Address - Fax:916-737-0262
Practice Address - Street 1:4801 34TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4849
Practice Address - Country:US
Practice Address - Phone:916-737-9202
Practice Address - Fax:916-737-0262
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator