Provider Demographics
NPI:1811033517
Name:DUONG, BAOCHAU THUY (DDS)
Entity Type:Individual
Prefix:
First Name:BAOCHAU
Middle Name:THUY
Last Name:DUONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16621 JIB CIR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3523
Mailing Address - Country:US
Mailing Address - Phone:562-533-0169
Mailing Address - Fax:
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:562-533-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice