Provider Demographics
NPI:1811331176
Name:LUONG, PHONG BINH I (PSYD)
Entity type:Individual
Prefix:DR
First Name:PHONG
Middle Name:BINH
Last Name:LUONG
Suffix:I
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PHONG
Other - Middle Name:BINH
Other - Last Name:LUONG
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3380 CORTE CASSIS
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1667
Mailing Address - Country:US
Mailing Address - Phone:714-360-7749
Mailing Address - Fax:
Practice Address - Street 1:3380 CORTE CASSIS
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1667
Practice Address - Country:US
Practice Address - Phone:714-360-7749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily