Provider Demographics
NPI:1295000602
Name:DUONG, DUC VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DUC
Middle Name:VAN
Last Name:DUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2329 PURDUE DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6365
Mailing Address - Country:US
Mailing Address - Phone:626-278-2373
Mailing Address - Fax:714-486-3054
Practice Address - Street 1:2329 PURDUE DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6365
Practice Address - Country:US
Practice Address - Phone:626-278-2373
Practice Address - Fax:714-486-3054
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC52526208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice