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General NPI Number Information
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NPI Number | 1184959967
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Entity Type | Organization
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Legal Business Name | CHAN, CHAN, CHEN & LUU, DDS, INC.
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 15260 FAIRGROVE AVE
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City | LA PUENTE
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State | CA
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Zip | 91744-1067
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Country | US
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Telephone | 626-968-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 1043 W HUNTINGTON DR
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City | ARCADIA
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State | CA
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Zip | 91007-6536
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER LUU
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Credential | DDS
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Telephone | 626-236-6659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 55933
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License Number State | CA
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