MEDICARE: DR. MARK MINH NGO M.D.

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	207RH0003X	Hematology & Oncology Physician	A73755	CA

General Provider Information

NPI Number	:	1982623468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK MINH NGO M.D.

Provider Business Mailing Address
First Line	:	1043 ELM AVE
Second Line	:	STE 104
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3244
Country	:	US
Telephone Number	:	562-590-0345
Fax Number	:	562-437-8139

Provider Business Practice Location Address
First Line	:	1043 ELM AVE
Second Line	:	STE 104
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3271
Country	:	US
Telephone Number	:	562-590-0345
Fax Number	:	562-437-8139

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/20/2010

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