Healthcare Provider Details

I. General information

NPI: 1770503997
Provider Name (Legal Business Name): TAN DINH NGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 EDINGER AVE
WESTMINSTER CA
92683-7425
US

IV. Provider business mailing address

9431 EDINGER AVE
WESTMINSTER CA
92683-7425
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-8400
  • Fax: 714-839-8230
Mailing address:
  • Phone: 714-839-8400
  • Fax: 714-839-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG75839L
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: