MEDICARE: NGA THI LUU

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	1223G0001X	General Practice Dentistry	48953	CA

General Provider Information

NPI Number	:	1770770711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGA THI LUU

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	06/18/2010

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Directions to “ NGA THI LUU ” Practice Location

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