Healthcare Provider Details

I. General information

NPI: 1689599508
Provider Name (Legal Business Name): KENDALL TIMOTHY LUMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N BROADWAY STE 102
SANTA ANA CA
92706-3927
US

IV. Provider business mailing address

1600 N BROADWAY STE 102
SANTA ANA CA
92706-3927
US

V. Phone/Fax

Practice location:
  • Phone: 844-833-8444
  • Fax:
Mailing address:
  • Phone: 844-833-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: