Healthcare Provider Details

I. General information

NPI: 1831659945
Provider Name (Legal Business Name): CHRISTOPHER C DUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date: 05/15/2019
Reactivation Date: 05/22/2019

III. Provider practice location address

2114 PULLMAN LN # B
REDONDO BEACH CA
90278-4914
US

IV. Provider business mailing address

2114 PULLMAN LN # B
REDONDO BEACH CA
90278-4914
US

V. Phone/Fax

Practice location:
  • Phone: 310-279-3790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: