Healthcare Provider Details

I. General information

NPI: 1588937361
Provider Name (Legal Business Name): LIN DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date: 04/22/2015
Reactivation Date: 03/07/2016

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1025
  • Fax:
Mailing address:
  • Phone: 707-651-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number60118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: