Healthcare Provider Details

I. General information

NPI: 1659432904
Provider Name (Legal Business Name): THANG VI DUONG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S ATLANTIC BLVD
MONTEREY PARK CA
91754-4715
US

IV. Provider business mailing address

933 S ATLANTIC BLVD
MONTEREY PARK CA
91754-4715
US

V. Phone/Fax

Practice location:
  • Phone: 626-308-0943
  • Fax: 626-308-9142
Mailing address:
  • Phone: 626-308-0943
  • Fax: 626-308-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49875
License Number StateCA

VIII. Authorized Official

Name: DR. THANG VI DUONG
Title or Position: CHAIR-OWNER
Credential: DDS
Phone: 626-308-0943