Provider Demographics
NPI:1073835310
Name:DUONG, DUNG TRONG
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:TRONG
Last Name:DUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:TRONG
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2009 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-1121
Mailing Address - Country:US
Mailing Address - Phone:408-347-8850
Mailing Address - Fax:
Practice Address - Street 1:2009 RIDGEMONT DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-1121
Practice Address - Country:US
Practice Address - Phone:408-347-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health