Healthcare Provider Details

I. General information

NPI: 1407774912
Provider Name (Legal Business Name): LUCIANO FRANCISCO JIMENEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 IMPERIAL HWY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

8200 W MANCHESTER AVE APT 16
PLAYA DEL REY CA
90293-8182
US

V. Phone/Fax

Practice location:
  • Phone: 562-385-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: