Healthcare Provider Details

I. General information

NPI: 1134737745
Provider Name (Legal Business Name): GARY A LUU D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
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 TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

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