Provider Demographics
NPI:1023181658
Name:DUONG, PAUL T (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:DUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 BOLSA AVE
Mailing Address - Street 2:SUITE # A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5964
Mailing Address - Country:US
Mailing Address - Phone:714-839-7332
Mailing Address - Fax:
Practice Address - Street 1:9433 BOLSA AVE
Practice Address - Street 2:SUITE # A
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5964
Practice Address - Country:US
Practice Address - Phone:714-839-7332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G663251Medicaid
CAF57106Medicare UPIN
CA00G663251Medicaid