Provider Demographics
NPI:1659426641
Name:DUONG, KIEU (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:KIEU
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:KELCY
Other - Middle Name:
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:4210 CRYSTAL HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2470 BERRYESSA RD STE E
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1309
Practice Address - Country:US
Practice Address - Phone:408-258-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11039171100000X
CADC27420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0274200Medicare ID - Type Unspecified