Provider Demographics
NPI:1376153643
Name:DUONG, PHUNG KIM (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:PHUNG
Middle Name:KIM
Last Name:DUONG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GLENRIDGE DR STE 1-208
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-7135
Mailing Address - Country:US
Mailing Address - Phone:470-223-8123
Mailing Address - Fax:
Practice Address - Street 1:5825 GLENRIDGE DR STE 1-208
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-7135
Practice Address - Country:US
Practice Address - Phone:470-223-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst