Healthcare Provider Details

I. General information

NPI: 1942681838
Provider Name (Legal Business Name): JOSEPH THANH-PHU DUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7505
  • Fax: 253-985-2853
Mailing address:
  • Phone: 253-274-7505
  • Fax: 253-985-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberMD61223241
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35140345
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61223241
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: