Provider Demographics
NPI:1659660835
Name:LUU, MYLAN DOAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYLAN
Middle Name:DOAN
Last Name:LUU
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 1:14291 EUCLID ST STE D114
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4985
Mailing Address - Country:US
Mailing Address - Phone:714-554-2054
Mailing Address - Fax:714-554-2056
Practice Address - Street 1:14291 EUCLID ST STE D114
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4985
Practice Address - Country:US
Practice Address - Phone:714-554-2054
Practice Address - Fax:714-554-2056
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice