Provider Demographics
NPI:1003350950
Name:DUONG, CHRISTINE PHAM (DNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PHAM
Last Name:DUONG
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:951-324-5901
Mailing Address - Fax:877-778-9472
Practice Address - Street 1:5549 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2068
Practice Address - Country:US
Practice Address - Phone:951-324-5901
Practice Address - Fax:877-778-9472
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004664363L00000X, 363LA2200X, 363LF0000X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01799521-DU4034OtherRAILROAD MEDICARE
CAP01799521-DU4034OtherRAILROAD MEDICARE