Healthcare Provider Details

I. General information

NPI: 1437447877
Provider Name (Legal Business Name): ANNIE LYNN PENACO DUONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE LYNN WONG PENACO M.D.

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E SUNSET RD B18
LV NV
89120
US

IV. Provider business mailing address

PO BOX 93358
LV NV
89193
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-6510
  • Fax: 702-405-7960
Mailing address:
  • Phone: 702-487-6510
  • Fax: 702-405-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number16203
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: