Provider Demographics
NPI:1053044768
Name:LUONG, THAI
Entity type:Individual
Prefix:
First Name:THAI
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 ZANELLA WAY STE E
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7170
Mailing Address - Country:US
Mailing Address - Phone:530-774-2975
Mailing Address - Fax:
Practice Address - Street 1:2565 ZANELLA WAY STE E
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7170
Practice Address - Country:US
Practice Address - Phone:530-774-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician