Healthcare Provider Details

I. General information

NPI: 1356226294
Provider Name (Legal Business Name): BRYANNE NGO MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14255 PEYTON DR
CHINO HILLS CA
91709-1607
US

IV. Provider business mailing address

812 MAERTIN LN
FULLERTON CA
92831-3016
US

V. Phone/Fax

Practice location:
  • Phone: 714-989-6829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number19187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: