Provider Demographics
NPI:1538257241
Name:DUONG, LONG NGUYEN THANH (MD)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:NGUYEN THANH
Last Name:DUONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2708 WESTMINSTER AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2192
Mailing Address - Country:US
Mailing Address - Phone:714-554-7350
Mailing Address - Fax:714-554-7481
Practice Address - Street 1:2708 WESTMINSTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2192
Practice Address - Country:US
Practice Address - Phone:714-554-7350
Practice Address - Fax:714-554-7481
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A740450Medicaid
CA00A740450Medicaid
CAI39318Medicare UPIN