Provider Demographics
NPI:1629510458
Name:SEUNG M KANG & LLOYD TRIEU DDS, INC.
Entity Type:Organization
Organization Name:SEUNG M KANG & LLOYD TRIEU DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-780-8831
Mailing Address - Street 1:17942 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9255
Mailing Address - Country:US
Mailing Address - Phone:951-780-8831
Mailing Address - Fax:951-780-8832
Practice Address - Street 1:17942 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9255
Practice Address - Country:US
Practice Address - Phone:951-780-8831
Practice Address - Fax:951-780-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295942985Medicaid
CA192297183Medicaid