Provider Demographics
NPI:1235163726
Name:DUONG, TAO (MD)
Entity Type:Individual
Prefix:DR
First Name:TAO
Middle Name:
Last Name:DUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 BOLSA AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6784
Mailing Address - Country:US
Mailing Address - Phone:714-418-9191
Mailing Address - Fax:714-418-9195
Practice Address - Street 1:10301 BOLSA AVE STE 209
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6784
Practice Address - Country:US
Practice Address - Phone:714-418-9191
Practice Address - Fax:714-418-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68522207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFU651ZOtherMEDICARE PTAN (INDIVIDUAL)
CA00G685220Medicaid