Provider Demographics
NPI:1366950651
Name:DUONG, LIEN NGOC (PHARMD)
Entity type:Individual
Prefix:
First Name:LIEN
Middle Name:NGOC
Last Name:DUONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 CLEVELAND AVE UNIT 319
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3384
Mailing Address - Country:US
Mailing Address - Phone:619-721-8631
Mailing Address - Fax:
Practice Address - Street 1:1270 CLEVELAND AVE UNIT 319
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3384
Practice Address - Country:US
Practice Address - Phone:619-721-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist