=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275755365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAN DINH NGO MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 11/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9431 EDINGER AVENUE
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-839-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9431 EDINGER AVENUE
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-839-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. TAN DINH NGO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-839-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | G75839
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------