MEDICARE: DR. NHIEN THUY LUU D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	48826	CA

General Provider Information

NPI Number	:	1104080167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NHIEN THUY LUU D.D.S.

Provider Business Mailing Address
First Line	:	407 N PACIFIC COAST HWY STE 392
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2872
Country	:	US
Telephone Number	:	424-257-0717
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 N PACIFIC COAST HWY STE 392
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2872
Country	:	US
Telephone Number	:	424-257-0717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	12/07/2023

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