Provider Demographics
NPI:1164405775
Name:DUONG, CHAU TRUNG (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHAU
Middle Name:TRUNG
Last Name:DUONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2816
Mailing Address - Country:US
Mailing Address - Phone:718-256-0580
Mailing Address - Fax:718-259-2208
Practice Address - Street 1:1602 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2816
Practice Address - Country:US
Practice Address - Phone:718-256-0580
Practice Address - Fax:718-259-2208
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004992213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01392263Medicaid
NY01392263Medicaid
NYP55991Medicare ID - Type Unspecified