Provider Demographics
NPI:1437447877
Name:DUONG, ANNIE LYNN PENACO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE LYNN
Middle Name:PENACO
Last Name:DUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNIE LYNN
Other - Middle Name:WONG
Other - Last Name:PENACO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 93358
Mailing Address - Street 2:
Mailing Address - City:LV
Mailing Address - State:NV
Mailing Address - Zip Code:89193
Mailing Address - Country:US
Mailing Address - Phone:702-487-6510
Mailing Address - Fax:702-405-7960
Practice Address - Street 1:2700 E SUNSET RD B18
Practice Address - Street 2:
Practice Address - City:LV
Practice Address - State:NV
Practice Address - Zip Code:89120
Practice Address - Country:US
Practice Address - Phone:702-487-6510
Practice Address - Fax:702-405-7960
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16203207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1437447877Medicaid