Healthcare Provider Details

I. General information

NPI: 1255007449
Provider Name (Legal Business Name): KEVIN NGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5020
US

IV. Provider business mailing address

920 SL YOUNG BLVD # 1140
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4351
  • Fax: 405-271-8695
Mailing address:
  • Phone: 405-271-4351
  • Fax: 405-271-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number94-12305
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: