Healthcare Provider Details

I. General information

NPI: 1730740697
Provider Name (Legal Business Name): LUONG LEE DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5753 E SANTA ANA CANYON RD STE K
ANAHEIM CA
92807-3230
US

IV. Provider business mailing address

5753 E SANTA ANA CANYON RD STE K
ANAHEIM CA
92807-3230
US

V. Phone/Fax

Practice location:
  • Phone: 714-998-4700
  • Fax:
Mailing address:
  • Phone: 714-366-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRIAN LUONG
Title or Position: ORTHODONTIST PARTNER
Credential: DMD MBA MS
Phone: 714-366-2032