Provider Demographics
NPI:1790422806
Name:LUONG, BIANCA CECILE
Entity Type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:CECILE
Last Name:LUONG
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 1:1340 COMMONWEALTH AVE APT 15
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3922
Mailing Address - Country:US
Mailing Address - Phone:915-538-7454
Mailing Address - Fax:
Practice Address - Street 1:1340 COMMONWEALTH AVE APT 15
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-3922
Practice Address - Country:US
Practice Address - Phone:915-538-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program