Provider Demographics
NPI:1033612791
Name:DUONG, TUAN-TU (L/CPO)
Entity Type:Individual
Prefix:
First Name:TUAN-TU
Middle Name:
Last Name:DUONG
Suffix:
Gender:M
Credentials:L/CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2200
Mailing Address - Country:US
Mailing Address - Phone:425-339-2559
Mailing Address - Fax:
Practice Address - Street 1:7631 212TH ST SW STE 102A
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7565
Practice Address - Country:US
Practice Address - Phone:425-776-1247
Practice Address - Fax:425-776-8045
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS60912919224P00000X
WAORTH.OI.60819114222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist