Healthcare Provider Details

I. General information

NPI: 1356264741
Provider Name (Legal Business Name): KD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E BROADWAY STE 107C
GLENDALE CA
91205-4043
US

IV. Provider business mailing address

225 E BROADWAY STE 107C
GLENDALE CA
91205-4043
US

V. Phone/Fax

Practice location:
  • Phone: 714-657-4991
  • Fax:
Mailing address:
  • Phone: 714-657-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KHANH TUAN DUONG
Title or Position: CEO/OWNER
Credential:
Phone: 714-657-4991