Healthcare Provider Details

I. General information

NPI: 1033612791
Provider Name (Legal Business Name): TUAN-TU DUONG L/CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7631 212TH ST SW STE 102A
EDMONDS WA
98026-7565
US

IV. Provider business mailing address

1300 44TH ST SE
EVERETT WA
98203-2200
US

V. Phone/Fax

Practice location:
  • Phone: 425-776-1247
  • Fax: 425-776-8045
Mailing address:
  • Phone: 425-339-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORTH.OI.60819114
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS60912919
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: