Basic Information
| Provider Information | |||||||||
| NPI: | 1073878096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUONG | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 STEIN PLZ | ||||||||
| Address2: | UCLA | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900957002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102069951 | ||||||||
| FaxNumber: | 3108256919 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STEIN PLZ | ||||||||
| Address2: | UNIVERSITY OF CALIFORNIA LOS ANGELES | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108255000 | ||||||||
| FaxNumber: | 3108256919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2012 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 14422 | CA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 14422TLG | 01 | CA | LICENSE | OTHER | OEG002598 | 01 | PA | LICENSE | OTHER |