Healthcare Provider Details

I. General information

NPI: 1063806511
Provider Name (Legal Business Name): MS. JEVER DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DUONG

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 N AVENUE 47
LOS ANGELES CA
90042-1613
US

IV. Provider business mailing address

1553 N AVENUE 47
LOS ANGELES CA
90042-1613
US

V. Phone/Fax

Practice location:
  • Phone: 808-979-1103
  • Fax:
Mailing address:
  • Phone: 808-979-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: