Provider Demographics
NPI:1629068523
Name:DUONG, HUNG (DDS)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:
Last Name:DUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12644 BUCKLEYS GATE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6631
Mailing Address - Country:US
Mailing Address - Phone:703-626-3472
Mailing Address - Fax:
Practice Address - Street 1:3800 FAIRFAX DR STE 6
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1703
Practice Address - Country:US
Practice Address - Phone:703-249-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026095122300000X
VA04014109831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist