Provider Demographics
NPI:1972989887
Name:SIMHAIRY, LUAY
Entity type:Individual
Prefix:
First Name:LUAY
Middle Name:
Last Name:SIMHAIRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10882 CALLE VERDE APT 118
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-8501
Mailing Address - Country:US
Mailing Address - Phone:619-760-3273
Mailing Address - Fax:
Practice Address - Street 1:10882 CALLE VERDE APT 118
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-8501
Practice Address - Country:US
Practice Address - Phone:619-760-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist