Provider Demographics
NPI:1578902359
Name:LUONG, ANDY VU (DDS)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:VU
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 1:12219 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2808
Mailing Address - Country:US
Mailing Address - Phone:316-681-1099
Mailing Address - Fax:
Practice Address - Street 1:12219 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2808
Practice Address - Country:US
Practice Address - Phone:316-681-1099
Practice Address - Fax:316-613-2417
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS610801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics