Provider Demographics
NPI:1679718399
Name:DUONG, MAN CONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MAN
Middle Name:CONG
Last Name:DUONG
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 1:423 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2846
Mailing Address - Country:US
Mailing Address - Phone:760-890-5432
Mailing Address - Fax:877-409-2620
Practice Address - Street 1:423 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2846
Practice Address - Country:US
Practice Address - Phone:760-890-5432
Practice Address - Fax:877-409-2620
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105702207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105702OtherMEDICAL LICENSE
CA1912919804OtherTYPE 2 NPI
CACB206363Medicare PIN
CA1912919804OtherTYPE 2 NPI