Provider Demographics
NPI:1801402912
Name:DUONG, VIVIAN NGUYEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:NGUYEN
Last Name:DUONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1188
Mailing Address - Country:US
Mailing Address - Phone:949-439-4080
Mailing Address - Fax:
Practice Address - Street 1:30251 ESPERANZA # R115
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2130
Practice Address - Country:US
Practice Address - Phone:949-713-7070
Practice Address - Fax:949-713-8994
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily