Provider Demographics
NPI:1699767111
Name:LUONG, GIAO VINH (DPM)
Entity type:Individual
Prefix:DR
First Name:GIAO
Middle Name:VINH
Last Name:LUONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S CLAREMONT ST
Mailing Address - Street 2:#13
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2118
Mailing Address - Country:US
Mailing Address - Phone:650-683-2073
Mailing Address - Fax:650-654-9054
Practice Address - Street 1:1417 S. CLAREMONT ST.
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2118
Practice Address - Country:US
Practice Address - Phone:650-683-2073
Practice Address - Fax:650-654-9054
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4293213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E42932Medicare ID - Type UnspecifiedMEDICARE