Basic Information
| Provider Information | |||||||||
| NPI: | 1265543490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUONG | ||||||||
| FirstName: | MAI | ||||||||
| MiddleName: | DUYEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 LAMAR CANYON LN | ||||||||
| Address2: | |||||||||
| City: | FRIENDSWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775463887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814823486 | ||||||||
| FaxNumber: | 2814824985 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 E PARKWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | FRIENDSWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775465149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814823486 | ||||||||
| FaxNumber: | 2814824985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L4352 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 161232715 | 05 | TX | MEDICAID |