Provider Demographics
NPI:1528237187
Name:SCOTT DUONG, DC
Entity type:Organization
Organization Name:SCOTT DUONG, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-396-5351
Mailing Address - Street 1:2701 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5200
Mailing Address - Country:US
Mailing Address - Phone:310-396-5351
Mailing Address - Fax:310-396-7858
Practice Address - Street 1:2701 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5200
Practice Address - Country:US
Practice Address - Phone:310-396-5351
Practice Address - Fax:310-396-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT345792251S0007X
CADC27749111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty