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NPI Code Detail

MEDICARE: DR. BRIAN TUAN LUONG D.M.D., M.B.A.

MEDICARE: DR. BRIAN TUAN LUONG D.M.D., M.B.A.
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
1122300000XDentist126NE
21223G0001XGeneral Practice Dentistry126NE
31223X0400XOrthodontics and Dentofacial Orthopedics Dentistry126NE
41223X0400XOrthodontics and Dentofacial Orthopedics Dentistry63276CA

General Provider Information

NPI Number : 1568868149
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN TUAN LUONG D.M.D., M.B.A.
Provider Business Mailing Address
First Line : 9702 SHANNON AVE
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92841-2652
Country : US
Telephone Number : 714-366-2032
Fax Number :
Provider Business Practice Location Address
First Line : 715 S MAIN ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-5717
Country : US
Telephone Number : 714-647-0797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 12/14/2020

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