Healthcare Provider Details

I. General information

NPI: 1003520073
Provider Name (Legal Business Name): ALBERT VINH KHIEM NGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 SEVILLE AVE
HUNTINGTON PARK CA
90255-6803
US

IV. Provider business mailing address

16617 HARROWAY AVE
CERRITOS CA
90703-1462
US

V. Phone/Fax

Practice location:
  • Phone: 562-852-3113
  • Fax:
Mailing address:
  • Phone: 562-852-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS106664
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD11744
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: