Provider Demographics
NPI:1073878096
Name:DUONG, CAROLYN M (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:DUONG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:300 STEIN PLZ
Mailing Address - Street 2:UCLA
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7002
Mailing Address - Country:US
Mailing Address - Phone:310-206-9951
Mailing Address - Fax:310-825-6919
Practice Address - Street 1:300 STEIN PLZ
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA LOS ANGELES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-5000
Practice Address - Fax:310-825-6919
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2020-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA14422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14422TLGOtherLICENSE
PAOEG002598OtherLICENSE