Provider Demographics
NPI:1992816268
Name:CUONG-DUNG DO, M.D., INC
Entity type:Organization
Organization Name:CUONG-DUNG DO, M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CUONG-DUNG
Authorized Official - Middle Name:TRONG
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-899-5670
Mailing Address - Street 1:9061 BOLSA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5558
Mailing Address - Country:US
Mailing Address - Phone:714-899-5670
Mailing Address - Fax:714-899-5558
Practice Address - Street 1:9061 BOLSA AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5558
Practice Address - Country:US
Practice Address - Phone:714-899-5670
Practice Address - Fax:714-899-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G838870Medicaid
4785570001Medicare NSC
CA00G838870Medicaid