Healthcare Provider Details

I. General information

NPI: 1821821208
Provider Name (Legal Business Name): JORDENE NGO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 WASHINGTON BLVD
WHITTIER CA
90606-3111
US

IV. Provider business mailing address

11245 WASHINGTON BLVD
WHITTIER CA
90606-3111
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-1208
  • Fax:
Mailing address:
  • Phone: 562-692-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: