Provider Demographics
NPI:1992933055
Name:LUONG, TIM VAN (PA)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:VAN
Last Name:LUONG
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6958 NEW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4912
Mailing Address - Country:US
Mailing Address - Phone:951-780-9787
Mailing Address - Fax:
Practice Address - Street 1:7761 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4200
Practice Address - Country:US
Practice Address - Phone:714-898-8888
Practice Address - Fax:714-901-7580
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant