MEDICARE: HUNG DUONG D.D.S

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	122300000X	Dentist	019026095	IL
2	1223G0001X	General Practice Dentistry	0401410983	VA

General Provider Information

NPI Number	:	1629068523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNG DUONG D.D.S

Provider Business Mailing Address
First Line	:	12644 BUCKLEYS GATE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-6631
Country	:	US
Telephone Number	:	703-626-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 FAIRFAX DR STE 6
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1703
Country	:	US
Telephone Number	:	703-249-4409
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/09/2019

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