Active NPI
Ellen Thao Luu, DMD
- Dentist
- Huntington Beach, CA
National Provider Identifier
1689167041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 103681
- Practice address
- 19720 Beach Blvd Ste a
Huntington Beach, CA 92648-3506 - Phone
- (714) 260-7190
- NPI assigned
- Jun 11, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 34040 | TX | |
| Dentist | 122300000X | 103681 | CA | Primary |
Addresses
Primary practice location
19720 Beach Blvd Ste a
Huntington Beach, CA 92648-3506
Mailing address
9702 Bolsa Ave SPC 10
Westminster, CA 92683-6620
Phone (714) 260-7190
Other practice location 1
9427 Culebra Rd # 110
San Antonio, TX 78251-3506
Phone (210) 446-1141
Other practice location 2
3030 Harbor Blvd, Ste G-1
Costa Mesa, CA 92626-3506
Phone (714) 260-7190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103681 | CA | MD | Dentist |
| 34040 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564617600000",
"number": "1689167041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9702 BOLSA AVE SPC 10",
"city": "WESTMINSTER",
"state": "CA",
"postal_code": "926836620",
"telephone_number": "714-260-7190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19720 BEACH BLVD STE A",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926483506",
"telephone_number": "714-260-7190"
}
],
"practiceLocations": [
{
"address_1": "9427 Culebra Rd # 110",
"address_purpose": "LOCATION",
"city": "San Antonio",
"state": "TX",
"postal_code": "782513506",
"country_code": "US",
"telephone_number": "210-446-1141",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3030 Harbor Blvd, Ste G-1",
"address_purpose": "LOCATION",
"city": "Costa Mesa",
"state": "CA",
"postal_code": "926263506",
"country_code": "US",
"telephone_number": "714-260-7190",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUU",
"first_name": "ELLEN",
"middle_name": "THAO",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-11",
"last_updated": "2019-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "34040",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "103681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.