Provider Demographics
NPI:1952446304
Name:DUONG, HAO QUANG (MD)
Entity Type:Individual
Prefix:
First Name:HAO
Middle Name:QUANG
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 1:173 N MORRISON AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2712
Mailing Address - Country:US
Mailing Address - Phone:408-297-3022
Mailing Address - Fax:
Practice Address - Street 1:173 N MORRISON AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2712
Practice Address - Country:US
Practice Address - Phone:408-297-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA421162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A421160Medicaid
CA0001003361OtherSANTA CLARA CO. MH DEPT.
CA0001003361OtherSANTA CLARA CO. MH DEPT.
CA00A421160Medicare ID - Type Unspecified