Provider Demographics
NPI:1104046788
Name:EDISON C. LOUIE, DDS, INC.
Entity type:Organization
Organization Name:EDISON C. LOUIE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDISON
Authorized Official - Middle Name:CHUNG
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-998-5710
Mailing Address - Street 1:500 S ANAHEIM HILLS RD
Mailing Address - Street 2:STE 220
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4759
Mailing Address - Country:US
Mailing Address - Phone:714-998-5710
Mailing Address - Fax:714-998-3532
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:STE 220
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4759
Practice Address - Country:US
Practice Address - Phone:714-998-5710
Practice Address - Fax:714-998-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty