MEDICARE: DR. PHONG BINH LUONG I PSY.D.

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	103TF0000X	Family Psychologist

General Provider Information

NPI Number	:	1811331176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHONG BINH LUONG I PSY.D.

Provider Business Mailing Address
First Line	:	3380 CORTE CASSIS
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1667
Country	:	US
Telephone Number	:	714-360-7749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 CORTE CASSIS
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1667
Country	:	US
Telephone Number	:	714-360-7749
Fax Number	:

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	04/17/2013

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