Healthcare Provider Details

I. General information

NPI: 1104602986
Provider Name (Legal Business Name): MISS TAMMY NGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

IV. Provider business mailing address

PO BOX 5051
SANTA ANA CA
92704-0051
US

V. Phone/Fax

Practice location:
  • Phone: 562-943-7125
  • Fax:
Mailing address:
  • Phone: 949-414-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: