Provider Demographics
NPI:1407234644
Name:DUONG, TRANG
Entity Type:Individual
Prefix:DR
First Name:TRANG
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 1:1502 N HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1550
Mailing Address - Country:US
Mailing Address - Phone:510-331-6277
Mailing Address - Fax:
Practice Address - Street 1:10138 GARVEY AVE STE C
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-5002
Practice Address - Country:US
Practice Address - Phone:626-361-7055
Practice Address - Fax:626-768-7112
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5164213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB274256OtherMEDICARE