Individual provider · NPI-1

Kalu B Long, MD

Internal Medicine · Espanola, NM

NPI number1770119679
StatusActive
Last updated in NPPESAug 9, 2023

Details

NPI
1770119679
Entity type
Individual (NPI-1)
Name
Kalu B Long
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Mar 23, 2020
Certification date
Jul 31, 2023
Last updated
Aug 9, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineMD2023-1039NMYes

Practice location

1010 Spruce St
Espanola, NM 87532-2724

Phone 505-753-7111

Mailing address

Po Box 26666
Provider Enrollment
Albuquerque, NM 87125-6666

Phone 505-923-6770 · Fax 505-923-5354

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