Provider Demographics
NPI:1497705289
Name:DUONG, VAN HONG (MD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:HONG
Last Name:DUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 FLOWER ST STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3000
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:
Practice Address - Street 1:1500 W WEST COVINA PKWY
Practice Address - Street 2:STE 101
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2703
Practice Address - Country:US
Practice Address - Phone:626-263-7020
Practice Address - Fax:626-960-3726
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A412780Medicaid
CADA727ZMedicare PIN
CAC46026Medicare UPIN