Healthcare Provider Details

I. General information

NPI: 1275755365
Provider Name (Legal Business Name): TAN DINH NGO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9431 EDINGER AVENUE
WESTMINSTER CA
92683
US

IV. Provider business mailing address

9431 EDINGER AVENUE
WESTMINSTER CA
92683
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberG75839
License Number StateCA

VIII. Authorized Official

Name: DR. TAN DINH NGO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-839-8400