MEDICARE: NANCY NGA LUU, D.D.S., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1427298884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY NGA LUU, D.D.S., INC.

Provider Business Mailing Address
First Line	:	9641 E STOCKTON BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-2564
Country	:	US
Telephone Number	:	916-686-8626
Fax Number	:	916-686-8634

Provider Business Practice Location Address
First Line	:	9641 E STOCKTON BLVD
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-2564
Country	:	US
Telephone Number	:	916-686-8626
Fax Number	:	916-686-8634

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NANCY NGA LUU
Credential	:	D.D.S.
Telephone Number	:	916-686-8626

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	02/25/2009

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