NPIMap

Individual provider Active NPI

Khanh Tan Duong, MD

  • Internal Medicine Physician
  • Montclair, CA
National Provider Identifier
1225528466
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A174153 Issued in CA
Practice address
9635 Monte Vista Ave Ste 208
Montclair, CA 91763-2235
Phone
(909) 255-0199
Fax
(216) 208-1435
NPI assigned
May 14, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BP10064981 TX
Internal Medicine Physician 207R00000X A174153 CA Primary

Addresses

Primary practice location

9635 Monte Vista Ave Ste 208
Montclair, CA 91763-2235

Mailing address

9635 Monte Vista Ave Ste 208
Montclair, CA 91763-2235
Phone (909) 255-0199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211129001121 CA Practitioner - Internal Medicine 7113270026 Reassigns benefits to 2 organizations
Practice locations: Montclair, CA; West Covina, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Physicians of California IncGroup PAC ID 8426062027, 120 clinicians

Practice addresses (Care Compare)

18300 US Hwy 18
Apple Valley, CA 92307-2206
Phone (760) 242-2311

Hospital & facility affiliations

  • Providence St Mary Medical Center Hospital, Apple Valley, CA, CCN 050300
  • Pomona Valley Hospital Medical Center Hospital, Pomona, CA, CCN 050231
  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
  • Barstow Community Hospital Hospital, Barstow, CA, CCN 050298

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A174153CAMDInternal Medicine Physician
BP10064981TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Khanh Tan Duong MD PC Current Accepting new patients
Hospitalist Medicine Physicians of California, Inc Internal Medicine CurrentSince Oct 1, 2021 Accepting new patients
Inpatient Specialists of California, PC Internal Medicine CurrentSince Oct 1, 2021 Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients
Dignity Health Past Accepting new patients
Dignity Health Past Accepting new patients
Dakota Specialty Institute Past Accepting new patients
Altru Health System Past Accepting new patients

Locations

18300 US Highway 18
Apple Valley, CA 92307
Phone (760) 424-2311

9635 Monte Vista Ave
Ste 208
Montclair, CA 91763
Phone (909) 255-0199

2101 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 881-4305

1800 N California St
Stockton, CA 95204
Phone (209) 467-6400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: khanh.duong@424122945241092.direct.elationemr.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1225528466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9635 MONTE VISTA AVE STE 208",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632235",
            "telephone_number": "909-255-0199",
            "fax_number": "216-208-1435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9635 MONTE VISTA AVE STE 208",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632235",
            "telephone_number": "909-255-0199",
            "fax_number": "216-208-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUONG",
        "first_name": "KHANH",
        "middle_name": "TAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-14",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "BP10064981",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A174153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

Verify at the official NPI Registry.