Healthcare Provider Details

I. General information

NPI: 1215362629
Provider Name (Legal Business Name): NGOC-TRUC THUY DUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 SUNSET BLVD
ROCKLIN CA
95765-3710
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD #100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-865-1000
  • Fax: 916-865-1005
Mailing address:
  • Phone: 866-681-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA126702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: