Provider Demographics
NPI:1922127703
Name:DUONG, DEREK DUNGQUANG (DMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:DUNGQUANG
Last Name:DUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 FAIRVIEW RD STE K
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1672
Mailing Address - Country:US
Mailing Address - Phone:949-515-9280
Mailing Address - Fax:949-515-9289
Practice Address - Street 1:2263 FAIRVIEW RD
Practice Address - Street 2:#K
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1672
Practice Address - Country:US
Practice Address - Phone:949-515-9280
Practice Address - Fax:949-515-9289
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489061223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice