Healthcare Provider Details

I. General information

NPI: 1245626647
Provider Name (Legal Business Name): PETER NGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE STE 104
LONG BEACH CA
90813-3244
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-0345
  • Fax: 562-437-8139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA178359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: