Active NPI
Tin Luong, D.D.S.
- Periodontics
- Escondido, CA
National Provider Identifier
1396030524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 61856
- Practice address
- 342 S Kalmia St
Escondido, CA 92025-4209 - Phone
- (760) 747-2020
- Fax
- (760) 747-0663
- NPI assigned
- Jun 15, 2011
- Last updated
- Oct 3, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 61856 | CA | Primary |
Addresses
Primary practice location
342 S Kalmia St
Escondido, CA 92025-4209
Mailing address
342 S Kalmia St
Escondido, CA 92025-4209
Phone (760) 747-2020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61856 | CA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412294400000",
"number": "1396030524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "342 S KALMIA ST",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920254209",
"telephone_number": "760-747-2020",
"fax_number": "760-747-0663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "342 S KALMIA ST",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920254209",
"telephone_number": "760-747-2020",
"fax_number": "760-747-0663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUONG",
"first_name": "TIN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-15",
"last_updated": "2014-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "61856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.