Provider Demographics
NPI:1295754125
Name:DUONG, KHANH TUAN (DPM)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:TUAN
Last Name:DUONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10282 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5782
Mailing Address - Country:US
Mailing Address - Phone:714-697-9939
Mailing Address - Fax:714-899-3493
Practice Address - Street 1:13701 BEACH BLVD A1
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5347
Practice Address - Country:US
Practice Address - Phone:714-705-0737
Practice Address - Fax:310-618-6989
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE 4237213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80449Medicare UPIN
CAE4237JMedicare PIN
CAE4237GMedicare PIN
CAE4237 DMedicare ID - Type UnspecifiedGENERAL PODIATRY
CAE4237IMedicare PIN