Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 42356 | CA |
Y | 213EG0000X | General Practice | 42356 | CA |
NPI | 1003932948 |
---|---|
Provider Name | Dr. Donald Luong |
First Address | Lakewood, CA 90713-3141 |
Second Address | Lakewood, CA 90713-3141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42356 | DENTAL LICENSE (01) | CA |
D42356 | DENTICAL RENDER. ID (01) | CA |