Healthcare Provider Details

I. General information

NPI: 1295429231
Provider Name (Legal Business Name): KRISTIE LINH NGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 E PACIFIC COAST HWY UNIT 3
LONG BEACH CA
90804-3229
US

IV. Provider business mailing address

14371 TAFT ST
GARDEN GROVE CA
92843-5048
US

V. Phone/Fax

Practice location:
  • Phone: 562-580-2669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: