Provider Demographics
NPI:1760441653
Name:DU, TRI QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:TRI
Middle Name:QUOC
Last Name:DU
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 1:1732 RIVERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7630
Mailing Address - Country:US
Mailing Address - Phone:281-636-8899
Mailing Address - Fax:504-348-3935
Practice Address - Street 1:1732 RIVERCREEK DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7630
Practice Address - Country:US
Practice Address - Phone:281-636-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307560208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1051039Medicaid
4F465Medicare ID - Type Unspecified
LA1051039Medicaid