Provider Demographics
NPI:1215396411
Name:LUM, GIANNA CRISTINA LIGOURI
Entity type:Individual
Prefix:DR
First Name:GIANNA
Middle Name:CRISTINA LIGOURI
Last Name:LUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 E LELAND RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4911
Mailing Address - Country:US
Mailing Address - Phone:925-431-1250
Mailing Address - Fax:
Practice Address - Street 1:337 E LELAND RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4911
Practice Address - Country:US
Practice Address - Phone:925-431-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist