Provider Demographics
NPI:1669277752
Name:DUONG, DILLON VAN NGUYEN (DPT)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:VAN NGUYEN
Last Name:DUONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16270 CAYENNE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3715
Mailing Address - Country:US
Mailing Address - Phone:858-663-0013
Mailing Address - Fax:
Practice Address - Street 1:9825 GLEN CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1689
Practice Address - Country:US
Practice Address - Phone:858-293-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT307118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist