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General NPI Number Information
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NPI Number | 1952542045
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Entity Type | Organization
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Legal Business Name | CALVIN M DUONG MD A MEDICAL CORP
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 625 W COLLEGE ST SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90012-1675
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Country | US
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Telephone | 213-617-8301
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Fax | 213-617-7057
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Provider Business Mailing Address
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Address Line | 625 W COLLEGE ST SUITE 201
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City | LOS ANGELES
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State | CA
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Zip | 90012-1675
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Country | US
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Telephone | 213-617-8301
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Fax | 213-617-7057
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CALVIN M DUONG
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Credential | M.D.
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Telephone | 213-617-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A91752
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A91752
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License Number State | CA
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