Provider Demographics
NPI:1578016911
Name:DUONG, AMBER THI (DPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:THI
Last Name:DUONG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:QUE-HUONG
Other - Middle Name:THI
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20823 STEVENS CREEK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2112
Mailing Address - Country:US
Mailing Address - Phone:408-252-6076
Mailing Address - Fax:408-252-1159
Practice Address - Street 1:20823 STEVENS CREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2112
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:408-252-1159
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29361ZOtherMEDICARE GROUP PTAN
CA1053320325OtherTYPE2 NPI
CACA233296Medicare PIN