Provider Demographics
NPI:1427082981
Name:DUONG, KEN KHANH (DDS)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:KHANH
Last Name:DUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 W. CRAIG RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130
Mailing Address - Country:US
Mailing Address - Phone:702-656-5273
Mailing Address - Fax:702-656-5805
Practice Address - Street 1:4990 W. CRAIG RD
Practice Address - Street 2:SUITE 15
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130
Practice Address - Country:US
Practice Address - Phone:702-656-5273
Practice Address - Fax:702-656-5805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice