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General NPI Number Information
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NPI Number | 1285210989
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Entity Type | Individual
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Provider Name | JENNIFER THAO NGO
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Gender | Female
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 55 E JULIAN ST
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City | SAN JOSE
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State | CA
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Zip | 95112-4007
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Country | US
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Telephone | 84-577-1004
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Fax | 408-918-2690
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Provider Business Mailing Address
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Address Line | 160 E VIRGINIA ST STE 100
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City | SAN JOSE
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State | CA
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Zip | 95112-5865
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Country | US
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Telephone | 408-938-2172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A22308
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License Number State | CA
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