Healthcare Provider Details

I. General information

NPI: 1013923903
Provider Name (Legal Business Name): TU-SON NGO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14149B ROBERT PARIS CT
CHANTILLY VA
20151-4201
US

IV. Provider business mailing address

14149B ROBERT PARIS CT
CHANTILLY VA
20151-4201
US

V. Phone/Fax

Practice location:
  • Phone: 703-389-9192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number49162
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401411494
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number13212
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: