Provider Demographics
NPI:1629277199
Name:LUONG, TIEN V (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:V
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 1:12879 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4100
Mailing Address - Country:US
Mailing Address - Phone:714-740-2051
Mailing Address - Fax:714-840-2051
Practice Address - Street 1:12879 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4100
Practice Address - Country:US
Practice Address - Phone:714-740-2051
Practice Address - Fax:714-840-2051
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice