Healthcare Provider Details

I. General information

NPI: 1700912920
Provider Name (Legal Business Name): PAUL NGOC MINH DUONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE SUITE 300
PHOENIX AZ
85027-3250
US

IV. Provider business mailing address

20414 N 27TH AVE STE 300
PHOENIX AZ
85027-3250
US

V. Phone/Fax

Practice location:
  • Phone: 623-879-6000
  • Fax: 623-516-2000
Mailing address:
  • Phone: 623-879-6000
  • Fax: 623-516-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number30045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: