Provider Demographics
NPI:1356364889
Name:DUONG, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
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:DEPT. LA 23039
Mailing Address - Street 2:ATTENTION: MAGGIE NOLES MS 6160
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-3039
Mailing Address - Country:US
Mailing Address - Phone:562-344-1150
Mailing Address - Fax:562-344-1155
Practice Address - Street 1:4540 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4327
Practice Address - Country:US
Practice Address - Phone:562-344-1150
Practice Address - Fax:562-344-1155
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A666850Medicaid
00A666850OtherBLUE SHIELD ID #
CAH04684Medicare UPIN
CA00A666850Medicaid
CAWA66685CMedicare PIN