Healthcare Provider Details

I. General information

NPI: 1003068065
Provider Name (Legal Business Name): A. NGO M.D. PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W COMMONWEALTH AVE
FULLERTON CA
92832-1723
US

IV. Provider business mailing address

508 W COMMONWEALTH AVE
FULLERTON CA
92832-1723
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-4963
  • Fax:
Mailing address:
  • Phone: 714-879-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA54744
License Number StateCA

VIII. Authorized Official

Name: DR. ANH THIEN NGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-879-4963