Basic Information
| Provider Information | |||||||||
| NPI: | 1588823819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUONG | ||||||||
| FirstName: | WINI | ||||||||
| MiddleName: | ZERLINE | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 22210 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105352965 | ||||||||
| FaxNumber: | 5105354128 | ||||||||
| Practice Location | |||||||||
| Address1: | 2920 SONOMA BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | VALLEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945903879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075582000 | ||||||||
| FaxNumber: | 7076443507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 56391 | CA | Y | Dental Providers | Dentist | General Practice | 122300000X | 019.028185 | IL | N | Dental Providers | Dentist |
No ID Information.