Provider Demographics
NPI:1396030524
Name:LUONG, TIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIN
Middle Name:
Last Name:LUONG
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 1:342 S KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4209
Mailing Address - Country:US
Mailing Address - Phone:760-747-2020
Mailing Address - Fax:760-747-0663
Practice Address - Street 1:342 S KALMIA ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4209
Practice Address - Country:US
Practice Address - Phone:760-747-2020
Practice Address - Fax:760-747-0663
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618561223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics