Healthcare Provider Details

I. General information

NPI: 1205843133
Provider Name (Legal Business Name): STEVEN YEE LUO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 9TH ST
IMPERIAL BEACH CA
91932-1508
US

IV. Provider business mailing address

629 9TH ST
IMPERIAL BEACH CA
91932-1508
US

V. Phone/Fax

Practice location:
  • Phone: 619-424-5115
  • Fax: 619-628-8129
Mailing address:
  • Phone: 619-424-5115
  • Fax: 619-628-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: