Healthcare Provider Details

I. General information

NPI: 1548600349
Provider Name (Legal Business Name): HUONG NGOC LUU PHLEMBOTOMIST ACSP E
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 DUNEIDER LN
CITY MANASSAS VA
20109
US

IV. Provider business mailing address

P.O. BOX 3408
MANASSAS VA
20109
US

V. Phone/Fax

Practice location:
  • Phone: 571-288-6728
  • Fax: 703-365-2153
Mailing address:
  • Phone: 571-288-6728
  • Fax: 703-365-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberPBT3118ASCP
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberC.E.K.G.T67011813000
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: