Individual provider Active NPI

Minh Nguyet Dao Luong, DDS

  • Dentist
  • Chicago, IL
National Provider Identifier
1629764600
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.036109 Issued in IL
Practice address
801 S Paulina St
Chicago, IL 60612-7210
Phone
(310) 990-3938
NPI assigned
Apr 13, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 109670 CA
Dentist 122300000X 019.036109 IL Primary

Addresses

Primary practice location

801 S Paulina St
Chicago, IL 60612-7210

Mailing address

714 Tiverton Ave
Los Angeles, CA 90095-3078
Phone (310) 990-3938

Other practice location 1

714 Tiverton Ave
Los Angeles, CA 90095-8361
Phone (310) 990-3938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240604002207 CA Order and Referring Only - DentistPractitioner - Dentist 3476095647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.036109ILMDDentist

Interoperability endpoints

  • Direct secure messaging: mluong188950@uihealth.direct-ci.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752192000000",
    "number": "1629764600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 TIVERTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953078",
            "telephone_number": "310-990-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210",
            "telephone_number": "310-990-3938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "714 Tiverton Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900958361",
            "country_code": "US",
            "telephone_number": "310-990-3938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUONG",
        "first_name": "MINH",
        "middle_name": "NGUYET DAO",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-13",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109670",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.036109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.