Basic Information
| Provider Information | |||||||||
| NPI: | 1255568515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUONG | ||||||||
| FirstName: | LOAN | ||||||||
| MiddleName: | THUY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291253 | ||||||||
| FaxNumber: | 3607293185 | ||||||||
| Practice Location | |||||||||
| Address1: | 860 BELTLINE RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974771091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412226005 | ||||||||
| FaxNumber: | 5412226029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2009 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | P1636 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | BP10033765 | TX | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | DO159382 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BP10033765 | 01 | TX | TEXAS MEDICAL BOARD PHYSICIAN IN-TRAINING | OTHER |