Provider Demographics
NPI:1013070234
Name:DUONG, HAN VAN (MD& DO)
Entity Type:Individual
Prefix:
First Name:HAN
Middle Name:VAN
Last Name:DUONG
Suffix:
Gender:F
Credentials:MD& DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8632 VALLEY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1740
Mailing Address - Country:US
Mailing Address - Phone:626-572-0005
Mailing Address - Fax:
Practice Address - Street 1:8632 VALLEY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1740
Practice Address - Country:US
Practice Address - Phone:626-572-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88951207R00000X
CA20A8977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A889510Medicaid
CAI44053Medicare UPIN
CAW19277Medicare ID - Type UnspecifiedPROVIDER NUMBER