Healthcare Provider Details

I. General information

NPI: 1316281280
Provider Name (Legal Business Name): JENNY LUONG RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 CULVER DRIVE
IRVINE CA
92612
US

IV. Provider business mailing address

4447 CANDLEWOOD STREET
LAKEWOOD CA
90712
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-8220
  • Fax: 949-407-5278
Mailing address:
  • Phone: 657-241-9935
  • Fax: 657-276-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: