Healthcare Provider Details

I. General information

NPI: 1861894370
Provider Name (Legal Business Name): TUAN QUAN DUONG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 STOCKTON ST
SAN FRANCISCO CA
94133-3354
US

IV. Provider business mailing address

1520 STOCKTON ST
SAN FRANCISCO CA
94133-3354
US

V. Phone/Fax

Practice location:
  • Phone: 408-251-1410
  • Fax:
Mailing address:
  • Phone: 408-729-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: