Healthcare Provider Details

I. General information

NPI: 1912322181
Provider Name (Legal Business Name): GARY LUU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E GARVEY AVE STE 106
MONTEREY PARK CA
91755-3054
US

IV. Provider business mailing address

1101 E GARVEY AVE STE 106
MONTEREY PARK CA
91755-3054
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number63263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: