Basic Information
| Provider Information | |||||||||
| NPI: | 1285642108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUONG | ||||||||
| FirstName: | CHI | ||||||||
| MiddleName: | Q | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7150 E CAMELBACK RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852511200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022184072 | ||||||||
| FaxNumber: | 6022184076 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 E CAMELBACK RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852511200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022184072 | ||||||||
| FaxNumber: | 6022184076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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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 | 207R00000X | 3424 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3424 | 01 | AZ LICENSE | OTHER | 110213980 | 01 | RR MEDICARE | OTHER |