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General NPI Number Information
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NPI Number | 1396323671
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Entity Type | Organization
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Legal Business Name | NGO & PHAM DENTAL GROUP
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 502 W GRAND BLVD
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City | CORONA
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State | CA
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Zip | 92882-2118
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Country | US
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Telephone | 951-549-0878
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Fax | 951-496-4011
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Provider Business Mailing Address
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Address Line | 502 W GRAND BLVD
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City | CORONA
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State | CA
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Zip | 92882-2118
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Country | US
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Telephone | 951-549-0878
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Fax | 951-496-4011
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Authorized Official
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Title or Position | OWNER
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Name | TUNG SON NGO
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Credential | DDS
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Telephone | 951-549-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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