Provider Demographics
NPI:1144782046
Name:DUONG, QUEENIE TIEN (DO)
Entity Type:Individual
Prefix:DR
First Name:QUEENIE
Middle Name:TIEN
Last Name:DUONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 LAKE RIDGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3017
Mailing Address - Country:US
Mailing Address - Phone:817-633-9590
Mailing Address - Fax:817-633-9595
Practice Address - Street 1:5203 LAKE RIDGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3017
Practice Address - Country:US
Practice Address - Phone:817-633-9590
Practice Address - Fax:817-633-9595
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3075207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine