Healthcare Provider Details

I. General information

NPI: 1629682414
Provider Name (Legal Business Name): KATHERINE NGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 CAMPUS DR
IRVINE CA
92612-8650
US

IV. Provider business mailing address

27974 GREENLAWN CIR
LAGUNA NIGUEL CA
92677-3753
US

V. Phone/Fax

Practice location:
  • Phone: 949-509-9840
  • Fax:
Mailing address:
  • Phone: 949-632-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number75411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: