Healthcare Provider Details

I. General information

NPI: 1205987070
Provider Name (Legal Business Name): HOA QUYNH DUONG D.D.S. & YEN HAI DUONG D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13518 HARBOR BLVD A5
GARDEN GROVE CA
92843-3838
US

IV. Provider business mailing address

13518 HARBOR BLVD STE A5
GARDEN GROVE CA
92843-3840
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-5517
  • Fax: 714-530-6526
Mailing address:
  • Phone: 714-530-5517
  • Fax: 714-530-6526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number35876
License Number StateCA

VIII. Authorized Official

Name: DR. HOA QUYNH DUONG
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-530-5517