Provider Demographics
NPI:1053516187
Name:DOAN, DUY TU (PA-C)
Entity type:Individual
Prefix:MR
First Name:DUY
Middle Name:TU
Last Name:DOAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:THUAN
Other - Middle Name:TAM
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 W. PATTERSON STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-427-0537
Mailing Address - Fax:323-566-2676
Practice Address - Street 1:10007 STATE STREET
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:323-566-3157
Practice Address - Fax:323-566-2676
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant