Healthcare Provider Details

I. General information

NPI: 1376574012
Provider Name (Legal Business Name): ANH T. DUONG, M.D., A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35900 BOB HOPE DR STE 275
RANCHO MIRAGE CA
92270-1766
US

IV. Provider business mailing address

35900 BOB HOPE DR STE 275
RANCHO MIRAGE CA
92270-1766
US

V. Phone/Fax

Practice location:
  • Phone: 760-321-2500
  • Fax: 760-321-5720
Mailing address:
  • Phone: 760-321-2500
  • Fax: 760-321-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number00G781520
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number00G781520
License Number StateCA

VIII. Authorized Official

Name: ANH TUAN DUONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-321-2500