MEDICARE: DR. KHANH TUAN DUONG D.P.M.

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	213E00000X	Podiatrist	E 4237	CA

General Provider Information

NPI Number	:	1295754125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHANH TUAN DUONG D.P.M.

Provider Business Mailing Address
First Line	:	10282 PARKVIEW AVE
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5782
Country	:	US
Telephone Number	:	714-697-9939
Fax Number	:	714-899-3493

Provider Business Practice Location Address
First Line	:	13701 BEACH BLVD A1
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5347
Country	:	US
Telephone Number	:	714-705-0737
Fax Number	:	310-618-6989

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/16/2015

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