Healthcare Provider Details

I. General information

NPI: 1326321647
Provider Name (Legal Business Name): VIVIAN QUYNH LUONG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 HOLDREGE STREET #11
LINCOLN NE
68501
US

IV. Provider business mailing address

4241 HOLDREGE STREET #11
LINCOLN NE
68501
US

V. Phone/Fax

Practice location:
  • Phone: 714-855-6863
  • Fax:
Mailing address:
  • Phone: 714-855-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number59775
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number59775
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: