Healthcare Provider Details

I. General information

NPI: 1205272945
Provider Name (Legal Business Name): THAO DUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S
INDEPENDENCE MO
64057-2358
US

IV. Provider business mailing address

2550 N ESPLANADE ST
CUERO TX
77954-4736
US

V. Phone/Fax

Practice location:
  • Phone: 913-307-5812
  • Fax: 816-833-1760
Mailing address:
  • Phone: 361-275-6191
  • Fax: 361-275-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberQ1591
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA142202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: