Healthcare Provider Details

I. General information

NPI: 1881760809
Provider Name (Legal Business Name): BRIANNE LUU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date: 09/17/2020
Reactivation Date: 11/10/2020

III. Provider practice location address

232 N AZUSA AVE
AZUSA CA
91702
US

IV. Provider business mailing address

232 N AZUSA AVE
AZUSA CA
91702
US

V. Phone/Fax

Practice location:
  • Phone: 626-466-9596
  • Fax: 626-812-9473
Mailing address:
  • Phone: 626-466-9596
  • Fax: 626-812-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: