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General NPI Number Information
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NPI Number | 1386862092
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Entity Type | Organization
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Legal Business Name | HIEU QUY NGO D.M.D. INC.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 31952 DEL OBISPO ST SUITE #190
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3124
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Country | US
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Telephone | 949-493-0611
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Fax |
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Provider Business Mailing Address
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Address Line | 31952 DEL OBISPO ST SUITE #190
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3124
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Country | US
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Telephone | 949-493-0611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HIEU NGO
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Credential | D.M.D.
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Telephone | 949-493-0611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 53253
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License Number State | CA
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