Provider Demographics
NPI:1235903295
Name:LUAN, ANDY Z (DDS)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:Z
Last Name:LUAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CLARITA CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4950
Mailing Address - Country:US
Mailing Address - Phone:805-304-8230
Mailing Address - Fax:
Practice Address - Street 1:4200 CALIFORNIA ST STE 210
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1367
Practice Address - Country:US
Practice Address - Phone:415-668-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1093981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice