Provider Demographics
NPI:1225825235
Name:DUONG, JIMMY
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:DUONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SMARTY JONES ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2398
Mailing Address - Country:US
Mailing Address - Phone:505-702-9080
Mailing Address - Fax:
Practice Address - Street 1:7441 BARTLETT ST NE STE 1B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5916
Practice Address - Country:US
Practice Address - Phone:505-702-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker