Provider Demographics
NPI:1760170054
Name:DUONG, SON Q (DTCM)
Entity Type:Individual
Prefix:DR
First Name:SON
Middle Name:Q
Last Name:DUONG
Suffix:
Gender:M
Credentials:DTCM
Other - Prefix:DR
Other - First Name:SON
Other - Middle Name:Q
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DTCM
Mailing Address - Street 1:719 SPINDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-1346
Mailing Address - Country:US
Mailing Address - Phone:408-797-9536
Mailing Address - Fax:
Practice Address - Street 1:3425 S BASCOM AVE STE 101
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7300
Practice Address - Country:US
Practice Address - Phone:408-480-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19739171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist