Basic Information
| Provider Information | |||||||||
| NPI: | 1407157621 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUONG | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | PHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N STATE ST | ||||||||
| Address2: | IRD 620 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900891001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232267556 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 N STATE ST | ||||||||
| Address2: | IRD 620 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900891001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232267556 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A11438 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.