Provider Demographics
NPI:1629194956
Name:DUONG, VICKI PHUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:PHUONG
Last Name:DUONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7260 E SOUTHGATE DR
Mailing Address - Street 2:STE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2609
Mailing Address - Country:US
Mailing Address - Phone:916-428-8134
Mailing Address - Fax:916-428-1334
Practice Address - Street 1:7260 E SOUTHGATE DR
Practice Address - Street 2:STE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2609
Practice Address - Country:US
Practice Address - Phone:916-428-8134
Practice Address - Fax:916-428-1334
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL1524390200000X
CAA100109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1524OtherMEDICAL LICENSE
CAA100109OtherCA MEDICAL LICENSE
NVLL1524OtherMEDICAL LICENSE
CAA100109OtherCA MEDICAL LICENSE