Provider Demographics
NPI:1164968194
Name:DUONG, TAM
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13330 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3251
Mailing Address - Country:US
Mailing Address - Phone:562-864-7435
Mailing Address - Fax:562-864-7437
Practice Address - Street 1:13330 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3251
Practice Address - Country:US
Practice Address - Phone:562-864-7435
Practice Address - Fax:562-864-7437
Is Sole Proprietor?:No
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist