Provider Demographics
NPI:1013083047
Name:DUONG, VICKY (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 N LEMON ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1205
Mailing Address - Country:US
Mailing Address - Phone:714-525-5558
Mailing Address - Fax:714-525-8238
Practice Address - Street 1:1602 N LEMON ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1205
Practice Address - Country:US
Practice Address - Phone:714-525-5558
Practice Address - Fax:714-525-8238
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice