Healthcare Provider Details

I. General information

NPI: 1528237187
Provider Name (Legal Business Name): SCOTT DUONG, DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 OCEAN PARK BLVD SUITE 119
SANTA MONICA CA
90405-5200
US

IV. Provider business mailing address

2701 OCEAN PARK BLVD SUITE 119
SANTA MONICA CA
90405-5200
US

V. Phone/Fax

Practice location:
  • Phone: 310-396-5351
  • Fax: 310-396-7858
Mailing address:
  • Phone: 310-396-5351
  • Fax: 310-396-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT34579
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC27749
License Number StateCA

VIII. Authorized Official

Name: DR. SCOTT DUONG
Title or Position: OWNER
Credential: D.C.
Phone: 310-396-5351