Healthcare Provider Details

I. General information

NPI: 1871761825
Provider Name (Legal Business Name): HOI VAN LUU DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E GARVEY AVE 106
MONTEREY PARK CA
91755-3056
US

IV. Provider business mailing address

1101 E GARVEY AVE 106
MONTEREY PARK CA
91755-3056
US

V. Phone/Fax

Practice location:
  • Phone: 626-288-8940
  • Fax: 626-288-8940
Mailing address:
  • Phone: 626-288-8940
  • Fax: 626-288-8940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDU31660
License Number StateCA

VIII. Authorized Official

Name: DR. HOI VAN LUU
Title or Position: PRESIDENT
Credential: DDS
Phone: 626-288-8940