Healthcare Provider Details

I. General information

NPI: 1295370666
Provider Name (Legal Business Name): HENRY THINH DUONG LPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 N WHITE RD
SAN JOSE CA
95127-1439
US

IV. Provider business mailing address

438 N WHITE RD
SAN JOSE CA
95127-1439
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-6848
  • Fax: 408-259-2273
Mailing address:
  • Phone: 408-254-6848
  • Fax: 408-254-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number41445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: