MEDICARE: KD ENTERPRISE HOLDINGS

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E4494	CA
2	213EP1101X	Primary Podiatric Medicine Podiatrist	E4237	CA

General Provider Information

NPI Number	:	1790107738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KD ENTERPRISE HOLDINGS

Provider Business Mailing Address
First Line	:	13701 BEACH BLVD
Second Line	:	A1
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3203
Country	:	US
Telephone Number	:	714-414-5092
Fax Number	:

Provider Business Practice Location Address
First Line	:	13701 BEACH BLVD
Second Line	:	A1
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-5347
Country	:	US
Telephone Number	:	714-414-5092
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KHANH TUAN DUONG
Credential	:	DPM
Telephone Number	:	714-697-9939

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	01/10/2014

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