Provider Demographics
NPI:1437443207
Name:LUONG, LEENA LIN
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:LIN
Last Name:LUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 CAMINO ARROYO
Mailing Address - Street 2:S02002
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7351
Mailing Address - Country:US
Mailing Address - Phone:408-848-8171
Mailing Address - Fax:408-848-5832
Practice Address - Street 1:7150 CAMINO ARROYO
Practice Address - Street 2:S02002
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7351
Practice Address - Country:US
Practice Address - Phone:408-848-8171
Practice Address - Fax:408-848-5832
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist