1821280744 NPI number — TRUONG D. DUONG M.D., A MEDICAL CORPORATION

Table of content: (NPI 1821280744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821280744 NPI number — TRUONG D. DUONG M.D., A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUONG D. DUONG M.D., A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821280744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2077
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91708-2077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-773-8664
Provider Business Mailing Address Fax Number:
877-773-8640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9333 BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-773-8664
Provider Business Practice Location Address Fax Number:
877-773-8640
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUONG
Authorized Official First Name:
TRUONG
Authorized Official Middle Name:
DINH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-744-7983

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A70137 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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