Healthcare Provider Details

I. General information

NPI: 1376046185
Provider Name (Legal Business Name): LONG KHANH HUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8970 WARNER AVE
FOUNTAIN VALLEY CA
92708-3211
US

IV. Provider business mailing address

1050 LINDEN AVE
LONG BEACH CA
90813-3321
US

V. Phone/Fax

Practice location:
  • Phone: 714-477-8400
  • Fax: 714-477-8401
Mailing address:
  • Phone: 562-491-9140
  • Fax: 562-491-9146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA167103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: