Healthcare Provider Details

I. General information

NPI: 1821821208
Provider Name (Legal Business Name): JORDENE NGO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12302 GARDEN GROVE BLVD STE 6
GARDEN GROVE CA
92843-1802
US

IV. Provider business mailing address

12302 GARDEN GROVE BLVD STE 6
GARDEN GROVE CA
92843-1802
US

V. Phone/Fax

Practice location:
  • Phone: 714-590-2020
  • Fax:
Mailing address:
  • Phone: 714-590-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: