Healthcare Provider Details

I. General information

NPI: 1952015901
Provider Name (Legal Business Name): JAMIE KIEU NGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 PENINSULA AVE
SAN MATEO CA
94401-1653
US

IV. Provider business mailing address

5606 ASPEN GROVE LN
ELK GROVE CA
95757-8353
US

V. Phone/Fax

Practice location:
  • Phone: 650-286-4396
  • Fax:
Mailing address:
  • Phone: 916-891-9232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: