Healthcare Provider Details

I. General information

NPI: 1346575875
Provider Name (Legal Business Name): JOHN DUONG L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 THOMAS JOHNSON DR STE 13
FREDERICK MD
21702-4457
US

IV. Provider business mailing address

198 THOMAS JOHNSON DR STE 13
FREDERICK MD
21702-4457
US

V. Phone/Fax

Practice location:
  • Phone: 301-841-5233
  • Fax:
Mailing address:
  • Phone: 301-841-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01701
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: