MEDICARE: MRS. NGOC CHHOU RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1770047375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NGOC CHHOU RDH

Provider Business Mailing Address
First Line	:	1599 BURKS DR
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3579
Country	:	US
Telephone Number	:	770-876-7322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 MARTIN LUTHER KING JR DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3674
Country	:	US
Telephone Number	:	404-613-1478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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