Provider Demographics
NPI:1902426950
Name:LUONG, YEN HAI NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:YEN
Middle Name:HAI NGUYEN
Last Name:LUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3202
Mailing Address - Country:US
Mailing Address - Phone:530-666-3657
Mailing Address - Fax:530-666-1601
Practice Address - Street 1:351 COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3202
Practice Address - Country:US
Practice Address - Phone:530-666-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1048041223G0001X
CA1048041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice