MEDICARE: MS. KIM NGA DUONG LCSW

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	1041C0700X	Clinical Social Worker	LCS20747	CA

General Provider Information

NPI Number	:	1790012953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM NGA DUONG LCSW

Provider Business Mailing Address
First Line	:	P.O. BOX 4882
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1477
Country	:	US
Telephone Number	:	714-767-4225
Fax Number	:

Provider Business Practice Location Address
First Line	:	16152 BEACH BLVD STE 170
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3818
Country	:	US
Telephone Number	:	714-767-4225
Fax Number	:

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	08/26/2010

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