MEDICARE: DR. VICKY DUONG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	48803	CA

General Provider Information

NPI Number	:	1013083047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICKY DUONG DMD

Provider Business Mailing Address
First Line	:	1602 N LEMON ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-1205
Country	:	US
Telephone Number	:	714-525-5558
Fax Number	:	714-525-8238

Provider Business Practice Location Address
First Line	:	1602 N LEMON ST
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-1205
Country	:	US
Telephone Number	:	714-525-5558
Fax Number	:	714-525-8238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/06/2008

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