Provider Demographics
NPI:1811781958
Name:DUONG, DUNG THI MY
Entity type:Individual
Prefix:
First Name:DUNG
Middle Name:THI MY
Last Name:DUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 SENTER RD APT 252
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2632
Mailing Address - Country:US
Mailing Address - Phone:669-226-7318
Mailing Address - Fax:
Practice Address - Street 1:1908 SENTER RD APT 252
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2632
Practice Address - Country:US
Practice Address - Phone:669-226-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist