Active NPI
Jimmy Duong, LAC
- Prevention Professional
- Hanover, MA
National Provider Identifier
1063953545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 265058
- Practice address
- 90 Rockland St
Hanover, MA 02339-2235 - Phone
- (781) 829-9355
- NPI assigned
- Mar 16, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 265058 | MA | Primary |
Addresses
Primary practice location
90 Rockland St
Hanover, MA 02339-2235
Mailing address
5 J a McDermott Cir
Randolph, MA 02368-2753
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 265058 | MA | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489622400000",
"number": "1063953545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 J A MCDERMOTT CIR",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023682753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 ROCKLAND ST",
"city": "HANOVER",
"state": "MA",
"postal_code": "023392235",
"telephone_number": "781-829-9355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUONG",
"first_name": "JIMMY",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-16",
"last_updated": "2017-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "MA",
"license": "265058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hanover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.