Provider Demographics
NPI:1891462669
Name:DUONG, JIMMY BO (PT)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:BO
Last Name:DUONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16897 ALGONQUIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3811
Mailing Address - Country:US
Mailing Address - Phone:714-841-6162
Mailing Address - Fax:714-841-9912
Practice Address - Street 1:16897 ALGONQUIN ST STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3811
Practice Address - Country:US
Practice Address - Phone:714-841-6162
Practice Address - Fax:714-841-9912
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300856OtherPHYSICAL THERAPY BOARD OF CALIFORNIA