Provider Demographics
NPI:1588823819
Name:LUONG, WINI ZERLINE (DDS)
Entity Type:Individual
Prefix:
First Name:WINI
Middle Name:ZERLINE
Last Name:LUONG
Suffix:
Gender:F
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:P.O. BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623
Mailing Address - Country:US
Mailing Address - Phone:510-535-2965
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:2920 SONOMA BLVD STE A
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3879
Practice Address - Country:US
Practice Address - Phone:707-558-2000
Practice Address - Fax:707-644-3507
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563911223G0001X
IL019.028185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist