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General NPI Number Information
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NPI Number | 1477758167
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Entity Type | Individual
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Provider Name | PHUONG LIEN NGO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 1001 JEFFERSON BLVD STE 300
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3387
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Country | US
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Telephone | 916-372-7022
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Fax | 916-372-7226
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Provider Business Mailing Address
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Address Line | 1001 JEFFERSON BLVD STE 300
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3387
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Country | US
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Telephone | 916-372-7022
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Fax | 916-372-7226
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36183
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License Number State | CA
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