Provider Demographics
NPI:1356051312
Name:DUONG, CRYSTAL THAO (PA-S)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:THAO
Last Name:DUONG
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:NGOC
Other - Middle Name:THAO
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5701 IRONHORSE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-7702
Mailing Address - Country:US
Mailing Address - Phone:804-349-6516
Mailing Address - Fax:
Practice Address - Street 1:1602 SKIPWITH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5205
Practice Address - Country:US
Practice Address - Phone:804-289-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant