Healthcare Provider Details

I. General information

NPI: 1518333855
Provider Name (Legal Business Name): CASEY A LUU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/29/2021
Certification Date: 08/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E GARVEY AVE STE 106
MONTEREY PARK CA
91755
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 626-590-6750
  • Fax:
Mailing address:
  • Phone: 626-288-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number62018
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS64999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: