Healthcare Provider Details

I. General information

NPI: 1689796211
Provider Name (Legal Business Name): SCOTT L DUONG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 TORRANCE BLVD
REDONDO BEACH CA
90277-3325
US

IV. Provider business mailing address

410 TORRANCE BLVD
REDONDO BEACH CA
90277-3325
US

V. Phone/Fax

Practice location:
  • Phone: 310-396-5351
  • Fax: 310-396-7858
Mailing address:
  • Phone: 310-396-5351
  • Fax: 310-396-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC27749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: