Provider Demographics
NPI:1689309098
Name:NGUYEN-DUONG, KATHY (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:NGUYEN-DUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COURT ST APT 3SQ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-0129
Mailing Address - Country:US
Mailing Address - Phone:312-813-1821
Mailing Address - Fax:
Practice Address - Street 1:519 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7372
Practice Address - Country:US
Practice Address - Phone:718-768-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3019747152WC0802X
GAOPT003452152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management