Active NPI
Andre BT Duong, DDS
- Dentist
- Fountain Valley, CA
National Provider Identifier
1295947828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 37327
- Practice address
- 17150 Euclid St Ste 308
Fountain Valley, CA 92708-4092 - Phone
- (714) 434-1307
- Fax
- (714) 434-1307
- NPI assigned
- May 4, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 37327 | CA | Primary |
Addresses
Primary practice location
17150 Euclid St Ste 308
Fountain Valley, CA 92708-4092
Mailing address
17150 Euclid St Ste 308
Fountain Valley, CA 92708-4092
Phone (714) 434-1307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160531002308 | CA | Order and Referring Only - Oral Surgery | 8628368842 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37327 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295947828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17150 EUCLID ST STE 308",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084092",
"telephone_number": "714-434-1307",
"fax_number": "714-434-1307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17150 EUCLID ST STE 308",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927084092",
"telephone_number": "714-434-1307",
"fax_number": "714-434-1307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUONG",
"first_name": "ANDRE",
"middle_name": "BT",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "37327",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fountain Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.