Provider Demographics
NPI:1962577205
Name:LORA DUNG HUYNH, D.D.S., INC.
Entity type:Organization
Organization Name:LORA DUNG HUYNH, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-981-0709
Mailing Address - Street 1:639 AZEVEDO CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6201
Mailing Address - Country:US
Mailing Address - Phone:408-981-0709
Mailing Address - Fax:408-288-7780
Practice Address - Street 1:1331 MEDICAL CENTER DR STE H
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2900
Practice Address - Country:US
Practice Address - Phone:707-585-8599
Practice Address - Fax:707-585-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty