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General NPI Number Information
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NPI Number | 1568868149
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Entity Type | Individual
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Provider Name | BRIAN TUAN LUONG D.M.D., M.B.A.
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Gender | Male
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 715 S MAIN ST
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City | SANTA ANA
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State | CA
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Zip | 92701-5717
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Country | US
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Telephone | 714-647-0797
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Fax |
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Provider Business Mailing Address
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Address Line | 9702 SHANNON AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92841-2652
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Country | US
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Telephone | 714-366-2032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 126
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 126
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 126
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 63276
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License Number State | CA
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