Provider Demographics
NPI:1639791452
Name:DOAN, PETER DUNG-QUOC (MD)
Entity Type:Individual
Prefix:
First Name:PETER DUNG-QUOC
Middle Name:
Last Name:DOAN
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 1:12442 LIMONITE AVE UNIT 205
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2467
Mailing Address - Country:US
Mailing Address - Phone:909-429-2864
Mailing Address - Fax:909-429-2868
Practice Address - Street 1:12442 LIMONITE AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-2467
Practice Address - Country:US
Practice Address - Phone:909-429-2864
Practice Address - Fax:909-429-2868
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA181106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine