Healthcare Provider Details

I. General information

NPI: 1790300267
Provider Name (Legal Business Name): MR. QUANG MINH NGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11057 WARNER AVE
FOUNTAIN VALLEY CA
92708-4007
US

IV. Provider business mailing address

11057 WARNER AVE
FOUNTAIN VALLEY CA
92708-4007
US

V. Phone/Fax

Practice location:
  • Phone: 714-277-0449
  • Fax:
Mailing address:
  • Phone: 714-277-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number106779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: