Healthcare Provider Details

I. General information

NPI: 1689303240
Provider Name (Legal Business Name): EMILY DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 N TUSTIN AVE
SANTA ANA CA
92705-7827
US

IV. Provider business mailing address

2191 VENTIA
TUSTIN CA
92782-8714
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-9799
  • Fax:
Mailing address:
  • Phone: 714-474-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS112758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: