Healthcare Provider Details

I. General information

NPI: 1407886765
Provider Name (Legal Business Name): STEPHANE NGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N COURT ST
VISALIA CA
93291-4918
US

IV. Provider business mailing address

201 N COURT ST
VISALIA CA
93291-4918
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2046
  • Fax: 559-627-9079
Mailing address:
  • Phone: 559-627-2046
  • Fax: 559-627-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0063898
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA108867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: