Healthcare Provider Details

I. General information

NPI: 1366925414
Provider Name (Legal Business Name): QUOC TUAN MINH LUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14941 RIVERSIDE DR
RIVERSIDE CA
92518-2035
US

IV. Provider business mailing address

14941 RIVERSIDE DR
RIVERSIDE CA
92518-2035
US

V. Phone/Fax

Practice location:
  • Phone: 347-520-5874
  • Fax:
Mailing address:
  • Phone: 347-520-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number344406
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: