Provider Demographics
NPI:1295915239
Name:DU, ALYSSA NGA (DMD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:NGA
Last Name:DU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 PERKINS LN
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3903
Mailing Address - Country:US
Mailing Address - Phone:310-704-6553
Mailing Address - Fax:
Practice Address - Street 1:1704 PERKINS LN
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3903
Practice Address - Country:US
Practice Address - Phone:310-704-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice