NPIMap

Individual provider Active NPI

Jacky Luong, DO

  • Family Medicine Physician
  • Pleasanton, CA
National Provider Identifier
1639674567
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A18985 Issued in CA
Practice address
5568 Gibraltar Dr
Pleasanton, CA 94588-8544
Phone
(925) 534-6500
NPI assigned
Mar 23, 2018
Last updated
Apr 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A18985 CA Primary

Addresses

Primary practice location

5568 Gibraltar Dr
Pleasanton, CA 94588-8544

Mailing address

5568 Gibraltar Dr
Pleasanton, CA 94588-8544
Phone (925) 534-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210722002087 IL Practitioner - HospitalistPractitioner - Family Practice 9133522527 Reassigns benefits to 1 organization
I20210831003193 CA Practitioner - Family Practice 9133522527 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

5575 W Las Positas Blvd
Suite 130
Pleasanton, CA 94588-5800
Phone (925) 463-0590

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A18985CAMDFamily Medicine Physician
18985CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Jan 15, 2023 Accepting new patients
Stanford Health Care Current Accepting new patients
Stanford Health Care CurrentSince Jan 15, 2023 Accepting new patients
Swedish Covenant Management Services, Inc. Family Medicine Current Accepting new patients
University Healthcare Alliance CurrentSince Jul 25, 2021 Accepting new patients
Swedish Covenant Management Services, Inc CurrentSince Jun 8, 2021 Accepting new patients
Bay Imaging Consultants Medical Group Inc PastSince Jul 17, 2022 Accepting new patients

Locations

50 E Hamilton Ave
Ste 280
Campbell, CA 95008
Phone (408) 227-2646

1300 Crane St
Menlo Park, CA 94025
Phone (510) 785-5000

4725 1st St
Ste 100
Pleasanton, CA 94566
Phone (925) 462-7060

5568 Gibraltar Dr
Pleasanton, CA 94588
Phone (925) 534-6500

5575 W Las Positas Blvd
Ste 130
Pleasanton, CA 94588
Phone (925) 463-0395

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

5140 N California Ave
Chicago, IL 60625
Phone (773) 275-8811

5140 N California Ave
Ste 780
Chicago, IL 60625
Phone (773) 784-5140

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

Interoperability endpoints

  • Direct secure messaging: jluong317904@direct.stanfordhealthcare.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1639674567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5568 GIBRALTAR DR",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888544",
            "telephone_number": "925-534-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5568 GIBRALTAR DR",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888544",
            "telephone_number": "925-534-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUONG",
        "first_name": "JACKY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-23",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A18985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.