MEDICARE: DR. MINH-PHUONG LU DOAN MD

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	207W00000X	Ophthalmology Physician	MD34002	DC
2	207W00000X	Ophthalmology Physician	D0064828	MD
3	207W00000X	Ophthalmology Physician	A90807	CA
4	207W00000X	Ophthalmology Physician	0101240225	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A908070	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1124041942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINH-PHUONG LU DOAN MD

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	12255 FAIR LAKES PKWY
Second Line	:	KAISER PERMANENTE
City	:	FAIRFAX
State	:	VA
Zip	:	22033-3952
Country	:	US
Telephone Number	:	702-934-5700
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/07/2021

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