Provider Demographics
NPI:1326119892
Name:DUONG, THONG MINH (DDS)
Entity Type:Individual
Prefix:DR
First Name:THONG
Middle Name:MINH
Last Name:DUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 UNIVERSITY AVE
Mailing Address - Street 2:STE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1739
Mailing Address - Country:US
Mailing Address - Phone:858-603-9027
Mailing Address - Fax:
Practice Address - Street 1:4448 UNIVERSITY AVE
Practice Address - Street 2:STE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1739
Practice Address - Country:US
Practice Address - Phone:858-603-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice