Healthcare Provider Details

I. General information

NPI: 1194644112
Provider Name (Legal Business Name): ANDREW HOANG DUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8612 MADISON AVE
MIDWAY CITY CA
92655-1105
US

IV. Provider business mailing address

8612 MADISON AVE
MIDWAY CITY CA
92655-1105
US

V. Phone/Fax

Practice location:
  • Phone: 714-725-4772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: