Provider Demographics
NPI:1023264124
Name:DUONG, CHRISTOPHER KIM (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KIM
Last Name:DUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 KANSAS ST APT C
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4464
Mailing Address - Country:US
Mailing Address - Phone:310-804-2000
Mailing Address - Fax:
Practice Address - Street 1:3250 W PLEASANT RUN RD STE 190
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1041
Practice Address - Country:US
Practice Address - Phone:469-765-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist