Provider Demographics
NPI:1285642108
Name:DUONG, CHI QUYNH (DO)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:QUYNH
Last Name:DUONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 E INDIAN SCHOOL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5500
Mailing Address - Country:US
Mailing Address - Phone:602-522-1900
Mailing Address - Fax:602-381-3281
Practice Address - Street 1:4840 E INDIAN SCHOOL RD STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5500
Practice Address - Country:US
Practice Address - Phone:602-522-1900
Practice Address - Fax:602-381-3281
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110213980OtherRR MEDICARE
3424OtherAZ LICENSE
110213980OtherRR MEDICARE
H00069Medicare UPIN
AZZ63516Medicare PIN