Healthcare Provider Details

I. General information

NPI: 1689589285
Provider Name (Legal Business Name): BIN LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W CAMPBELL AVE STE D36
CAMPBELL CA
95008-1041
US

IV. Provider business mailing address

9250 TOWNE CENTRE DR UNIT 10
SAN DIEGO CA
92121-3005
US

V. Phone/Fax

Practice location:
  • Phone: 858-370-2175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: