Provider Demographics
NPI:1205667086
Name:DUONG, NOAH LE
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:LE
Last Name:DUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 INDIANA BLVD APT 353
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1545
Mailing Address - Country:US
Mailing Address - Phone:469-636-9142
Mailing Address - Fax:
Practice Address - Street 1:2901 INDIANA BLVD APT 353
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1545
Practice Address - Country:US
Practice Address - Phone:469-636-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136297126800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No126800000XDental ProvidersDental Assistant