Healthcare Provider Details

I. General information

NPI: 1710772488
Provider Name (Legal Business Name): RYAN DUONG RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14200 CULVER DR STE 290
IRVINE CA
92604-0329
US

IV. Provider business mailing address

2 CALANDRIA
IRVINE CA
92620-1819
US

V. Phone/Fax

Practice location:
  • Phone: 949-679-1637
  • Fax:
Mailing address:
  • Phone: 949-231-9254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number34379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: