MEDICARE: KATHY LUONG

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1801436860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY LUONG

Provider Business Mailing Address
First Line	:	2700 E FOOTHILL BLVD STE 100
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3443
Country	:	US
Telephone Number	:	626-824-0982
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 E FOOTHILL BLVD STE 100
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3443
Country	:	US
Telephone Number	:	626-824-0982
Fax Number	:	888-717-7674

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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Directions to “ KATHY LUONG ” Practice Location

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