Healthcare Provider Details

I. General information

NPI: 1861528663
Provider Name (Legal Business Name): QUANG CAT LUU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26726 CROWN VALLEY PKWY STE 200
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

26726 CROWN VALLEY PKWY STE 200
MISSION VIEJO CA
92691-8003
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-4361
  • Fax: 949-364-4495
Mailing address:
  • Phone: 949-364-4361
  • Fax: 949-364-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA82886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: