MEDICARE: DR. KEVIN THOMAS LUONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A71072	CA

General Provider Information

NPI Number	:	1700873320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN THOMAS LUONG MD

Provider Business Mailing Address
First Line	:	151 N SUNRISE AVE
Second Line	:	SUITE 1005
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2924
Country	:	US
Telephone Number	:	916-782-1217
Fax Number	:	916-782-7630

Provider Business Practice Location Address
First Line	:	151 N SUNRISE AVE
Second Line	:	SUITE 1005
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2924
Country	:	US
Telephone Number	:	916-782-1217
Fax Number	:	916-782-7630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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