Provider Demographics
NPI:1437320660
Name:DAT DUONG, M.D., INC.
Entity Type:Organization
Organization Name:DAT DUONG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAT
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-893-1212
Mailing Address - Street 1:13926 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4037
Mailing Address - Country:US
Mailing Address - Phone:714-893-1212
Mailing Address - Fax:714-893-1211
Practice Address - Street 1:13926 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4037
Practice Address - Country:US
Practice Address - Phone:714-893-1212
Practice Address - Fax:714-893-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089680Medicaid
CAH92713Medicare UPIN