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General NPI Number Information
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NPI Number | 1629132899
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Entity Type | Individual
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Provider Name | DZUNG DUC-TIEN MANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 6650 78TH AVENUE N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-2053
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Country | US
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Telephone | 727-548-7600
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Fax | 727-548-7608
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Provider Business Mailing Address
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Address Line | 6650 78TH AVENUE N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-2053
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Country | US
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Telephone | 727-548-7600
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Fax | 727-548-7608
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME86632
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 054429
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License Number State | GA
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