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General NPI Number Information
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NPI Number | 1306109913
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Entity Type | Organization
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Legal Business Name | EDWARD H. LUONG, DMD, INC.
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 3551 FARQUHAR AVE STE 103
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2003
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Country | US
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Telephone | 562-596-1655
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Fax | 562-799-9599
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Provider Business Mailing Address
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Address Line | 3551 FARQUHAR AVE STE 103
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2003
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Country | US
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Telephone | 562-596-1655
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Fax | 562-799-9599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD HUNG LUONG
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Credential | DMD
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Telephone | 562-596-1655
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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 | 54800
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License Number State | CA
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