Healthcare Provider Details

I. General information

NPI: 1548828221
Provider Name (Legal Business Name): HOANG, NGUYEN, & LU DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9912 CARMEL MOUNTAIN RD STE B
SAN DIEGO CA
92129-2808
US

IV. Provider business mailing address

9912 CARMEL MOUNTAIN RD STE B
SAN DIEGO CA
92129-2808
US

V. Phone/Fax

Practice location:
  • Phone: 858-538-9182
  • Fax:
Mailing address:
  • Phone: 858-538-9182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDY T HOANG
Title or Position: PRESIDENT
Credential: DDS
Phone: 858-538-9182