Healthcare Provider Details

I. General information

NPI: 1770476905
Provider Name (Legal Business Name): VI-KHOI DUONG DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18742 AMAR RD
WALNUT CA
91789-4168
US

IV. Provider business mailing address

18742 AMAR RD
WALNUT CA
91789-4168
US

V. Phone/Fax

Practice location:
  • Phone: 626-828-0564
  • Fax: 626-828-0425
Mailing address:
  • Phone: 626-828-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VI-KHOI KYLE DUONG
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-463-5058