Provider Demographics
NPI:1790107738
Name:KD ENTERPRISE HOLDINGS
Entity Type:Organization
Organization Name:KD ENTERPRISE HOLDINGS
Other - Org Name:KD PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:TUAN
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-697-9939
Mailing Address - Street 1:13701 BEACH BLVD
Mailing Address - Street 2:A1
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3203
Mailing Address - Country:US
Mailing Address - Phone:714-414-5092
Mailing Address - Fax:
Practice Address - Street 1:13701 BEACH BLVD
Practice Address - Street 2:A1
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5347
Practice Address - Country:US
Practice Address - Phone:714-414-5092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4237213EP1101X
CAE4494213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty