Healthcare Provider Details

I. General information

NPI: 1851957278
Provider Name (Legal Business Name): JAVID & LUONG DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE STE 102
CULVER CITY CA
90232-6834
US

IV. Provider business mailing address

3831 HUGHES AVE STE 102
CULVER CITY CA
90232-6834
US

V. Phone/Fax

Practice location:
  • Phone: 714-855-6863
  • Fax:
Mailing address:
  • Phone: 714-855-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIAN LUONG
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 714-855-6863