MEDICARE: TANYA HONG NGOC 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	122300000X	Dentist	104279	CA

General Provider Information

NPI Number	:	1629608112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA HONG NGOC DUONG

Provider Business Mailing Address
First Line	:	8396 TERRANOVA CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-7644
Country	:	US
Telephone Number	:	310-619-5586
Fax Number	:

Provider Business Practice Location Address
First Line	:	8396 TERRANOVA CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-7644
Country	:	US
Telephone Number	:	310-619-5586
Fax Number	:

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

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	01/23/2020

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Directions to “ TANYA HONG NGOC DUONG ” Practice Location

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