MEDICARE: QUAN THUC LUONG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	5101015876	MI
2	208000000X	Pediatrics Physician	20A11556	CA

General Provider Information

NPI Number	:	1336103456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUAN THUC LUONG D.O.

Provider Business Mailing Address
First Line	:	45104 10TH ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2310
Country	:	US
Telephone Number	:	661-942-2391
Fax Number	:	661-902-6639

Provider Business Practice Location Address
First Line	:	45104 10TH ST W
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-2310
Country	:	US
Telephone Number	:	661-942-2391
Fax Number	:	661-902-6639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	08/22/2011

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