Basic Information
| Provider Information | |||||||||
| NPI: | 1063551885 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUC H. DUONG, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8043 2ND ST | ||||||||
| Address2: | #105 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902413621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628621134 | ||||||||
| FaxNumber: | 5628619895 | ||||||||
| Practice Location | |||||||||
| Address1: | 8043 2ND ST | ||||||||
| Address2: | #105 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902413621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628621134 | ||||||||
| FaxNumber: | 5628619895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 06/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | DUONG | ||||||||
| AuthorizedOfficialFirstName: | DUC | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5628621134 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | G84028 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G840280 | 05 | CA | MEDICAID |