Provider Demographics
NPI:1780842146
Name:DUONG, CHUONG (DO)
Entity Type:Individual
Prefix:DR
First Name:CHUONG
Middle Name:
Last Name:DUONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171501
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75017-1501
Mailing Address - Country:US
Mailing Address - Phone:972-696-9775
Mailing Address - Fax:
Practice Address - Street 1:3321 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2345
Practice Address - Country:US
Practice Address - Phone:972-696-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-01
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6270207P00000X
PAOT011880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215809904Medicaid
TXTXB134682Medicare PIN