Provider Demographics
NPI:1336198902
Name:DUONG, ROBERT T (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
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 1:1401 S BERETANIA ST STE 107
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1871
Mailing Address - Country:US
Mailing Address - Phone:808-591-1504
Mailing Address - Fax:808-591-1506
Practice Address - Street 1:1401 S BERETANIA ST STE 107
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1871
Practice Address - Country:US
Practice Address - Phone:808-591-1504
Practice Address - Fax:808-591-1506
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-120322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203205OtherDPRTMNT LABOR & INDUSTRIE
HI506321Medicaid
HIMD12032-01OtherMDX HAWAII
HI506321Medicaid
HIG88784Medicare UPIN