Provider Demographics
NPI:1447345822
Name:DUONG, HAO DANH (DDS)
Entity type:Individual
Prefix:DR
First Name:HAO
Middle Name:DANH
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 1:15701 CRENSHAW BLVD.
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:310-679-7479
Mailing Address - Fax:
Practice Address - Street 1:15701 CRENSHAW BLVD.
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249
Practice Address - Country:US
Practice Address - Phone:310-679-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD29927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29927-01Medicaid
CA509460Medicare UPIN