Provider Demographics
NPI:1467740076
Name:LU, DICH NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DICH
Middle Name:NGUYEN
Last Name:LU
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 1:3620 S BRISTOL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7314
Mailing Address - Country:US
Mailing Address - Phone:714-432-0979
Mailing Address - Fax:
Practice Address - Street 1:3620 S BRISTOL ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7314
Practice Address - Country:US
Practice Address - Phone:714-432-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice