Provider Demographics
NPI:1285972422
Name:DUONG PANG, MY TU (RD)
Entity type:Individual
Prefix:
First Name:MY TU
Middle Name:
Last Name:DUONG PANG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MY
Other - Middle Name:TU
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2001 JUNIPERO SERRA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3899
Mailing Address - Country:US
Mailing Address - Phone:650-746-3140
Mailing Address - Fax:
Practice Address - Street 1:2001 JUNIPERO SERRA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014
Practice Address - Country:US
Practice Address - Phone:650-746-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01069919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered