Healthcare Provider Details

I. General information

NPI: 1053628735
Provider Name (Legal Business Name): DANH NGO PT, DPT, OCS, SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 LONG BEACH BLVD STE 106
LONG BEACH CA
90807-6025
US

IV. Provider business mailing address

3646 LONG BEACH BLVD STE 106
LONG BEACH CA
90807-6025
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-0876
  • Fax: 888-510-3678
Mailing address:
  • Phone: 562-548-0876
  • Fax: 888-510-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number30350
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT30340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: