Provider Demographics
NPI:1659432904
Name:THANG VI DUONG DDS INC
Entity Type:Organization
Organization Name:THANG VI DUONG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANG
Authorized Official - Middle Name:VI
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-308-0943
Mailing Address - Street 1:933 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4715
Mailing Address - Country:US
Mailing Address - Phone:626-308-0943
Mailing Address - Fax:626-308-9142
Practice Address - Street 1:933 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4715
Practice Address - Country:US
Practice Address - Phone:626-308-0943
Practice Address - Fax:626-308-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92496-01OtherMEDI-CAL PROVIDER NUMBER
CAB49875-01OtherDELTA DENTAL'S HEALTHY FA