Healthcare Provider Details

I. General information

NPI: 1588823819
Provider Name (Legal Business Name): WINI ZERLINE LUONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SONOMA BLVD STE A
VALLEJO CA
94590-3879
US

IV. Provider business mailing address

P.O. BOX 22210
OAKLAND CA
94623
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-2000
  • Fax: 707-644-3507
Mailing address:
  • Phone: 510-535-2965
  • Fax: 510-535-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number56391
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.028185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: