=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356264741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KD MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2026
-----------------------------------------------------
Last Update Date | 08/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 E BROADWAY STE 107C
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-4043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-657-4991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 E BROADWAY STE 107C
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-4043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-657-4991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | KHANH TUAN DUONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-657-4991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------