Healthcare Provider Details

I. General information

NPI: 1922192103
Provider Name (Legal Business Name): THUAN DUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KEARNEY ST
FREMONT CA
94538-2299
US

IV. Provider business mailing address

2350 W. EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6203
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG45409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: