Provider Demographics
NPI:1841269578
Name:DUONG, TRUNG CONG (MD)
Entity type:Individual
Prefix:
First Name:TRUNG
Middle Name:CONG
Last Name:DUONG
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 1:4708 DEXTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5288
Mailing Address - Country:US
Mailing Address - Phone:972-993-5050
Mailing Address - Fax:972-993-5051
Practice Address - Street 1:4708 DEXTER DR STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5288
Practice Address - Country:US
Practice Address - Phone:972-993-5050
Practice Address - Fax:972-993-5051
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023073207R00000X
TXL3955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2024481-01Medicaid
TX202448101Medicaid
LA1494224Medicaid
TX8AG046OtherBCBS
TX8AG046OtherBCBS
LA1494224Medicaid
TX202448101Medicaid
G63207Medicare UPIN