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NPI Code Detail

MEDICARE: KHA PHAN DUONG

MEDICARE: KHA PHAN DUONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist009864NY

General Provider Information

NPI Number : 1073293403
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHA PHAN DUONG
Provider Business Mailing Address
First Line : 278 N WICKHAM RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-8625
Country : US
Telephone Number : 321-253-9228
Fax Number : 321-253-9446
Provider Business Practice Location Address
First Line : 278 N WICKHAM RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-8625
Country : US
Telephone Number : 321-253-9228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2023
Last Update Date : 01/12/2026

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Directions to “ KHA PHAN DUONG ” Practice Location

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