Provider Demographics
NPI:1184922064
Name:THONG DUONG DDS
Entity type:Organization
Organization Name:THONG DUONG DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-521-6798
Mailing Address - Street 1:4448 UNIVERSITY AVE
Mailing Address - Street 2:STE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1739
Mailing Address - Country:US
Mailing Address - Phone:619-521-6798
Mailing Address - Fax:
Practice Address - Street 1:4448 UNIVERSITY AVE
Practice Address - Street 2:STE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1739
Practice Address - Country:US
Practice Address - Phone:619-521-6798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty