Healthcare Provider Details

I. General information

NPI: 1720553258
Provider Name (Legal Business Name): MAIDALY DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5326
US

IV. Provider business mailing address

5762 BOLSA AVE STE 101
HUNTINGTON BEACH CA
92649-1172
US

V. Phone/Fax

Practice location:
  • Phone: 248-436-4400
  • Fax:
Mailing address:
  • Phone: 714-292-2322
  • Fax: 714-866-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: