Healthcare Provider Details

I. General information

NPI: 1477269728
Provider Name (Legal Business Name): JOHNSON DUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E CAPITOL EXPY
SAN JOSE CA
95121-2415
US

IV. Provider business mailing address

1029 E CAPITOL EXPY
SAN JOSE CA
95121-2415
US

V. Phone/Fax

Practice location:
  • Phone: 408-629-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number87624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: