Provider Demographics
NPI:1295381937
Name:HUA, LUCY LUONG
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:LUONG
Last Name:HUA
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 1:986 BLAZINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2632
Mailing Address - Country:US
Mailing Address - Phone:408-702-8178
Mailing Address - Fax:
Practice Address - Street 1:888 OAK GROVE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4428
Practice Address - Country:US
Practice Address - Phone:650-817-8680
Practice Address - Fax:650-325-1431
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist