Provider Demographics
NPI:1407588296
Name:DUONG, KIEU THY
Entity Type:Individual
Prefix:
First Name:KIEU
Middle Name:THY
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 1:4272 TIMBER JUMP CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7353
Mailing Address - Country:US
Mailing Address - Phone:901-550-3414
Mailing Address - Fax:
Practice Address - Street 1:4272 TIMBER JUMP CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-7353
Practice Address - Country:US
Practice Address - Phone:901-550-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant