Provider Demographics
NPI:1245417765
Name:NGUYEN, LUONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9895 WARNER AVE STE E
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2933
Mailing Address - Country:US
Mailing Address - Phone:714-962-2788
Mailing Address - Fax:714-962-2988
Practice Address - Street 1:9895 WARNER AVE STE E
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2933
Practice Address - Country:US
Practice Address - Phone:714-962-2788
Practice Address - Fax:714-962-2988
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55846122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist