Provider Demographics
NPI:1972641595
Name:TIEU, LOUIS (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:TIEU
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 E HAMILTON AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0232
Mailing Address - Country:US
Mailing Address - Phone:408-871-2988
Mailing Address - Fax:
Practice Address - Street 1:281 E HAMILTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0232
Practice Address - Country:US
Practice Address - Phone:408-871-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446331223S0112X
CAA82866204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery