MEDICARE: KATHY 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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1104711399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY DUONG

Provider Business Mailing Address
First Line	:	208 ROBINSON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6216
Country	:	US
Telephone Number	:	347-987-6941
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 ROBINSON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6216
Country	:	US
Telephone Number	:	347-987-6941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “ KATHY DUONG ” Practice Location

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