Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95004664 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 95004664 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95004664 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 95004664 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95004664 | CA |
NPI | 1003350950 |
---|---|
Provider Name | Christine Pham Duong |
First Address | Long Beach, CA 90802-4317 |
Second Address | Riverside, CA 92503-2068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01799521-DU4034 | RAILROAD MEDICARE (01) | CA |