Healthcare Provider Details

I. General information

NPI: 1851204077
Provider Name (Legal Business Name): NGAN HOANG NGO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL NGO RN

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 ZELZAH AVE
GRANADA HILLS CA
91344-5902
US

IV. Provider business mailing address

10535 ZELZAH AVE
GRANADA HILLS CA
91344-5902
US

V. Phone/Fax

Practice location:
  • Phone: 818-360-2361
  • Fax: 818-206-8360
Mailing address:
  • Phone: 818-360-2361
  • Fax: 818-206-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number850056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: