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General NPI Number Information
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NPI Number | 1639436330
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Entity Type | Individual
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Provider Name | CHRISTOPHER S NGO DO
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Gender | Male
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 17014 NEW COLLEGE AVE STE B
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City | WILDWOOD
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State | MO
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Zip | 63040-1177
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Country | US
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Telephone | 618-235-8422
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Fax | 618-235-8427
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Provider Business Mailing Address
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Address Line | 17014 NEW COLLEGE AVE STE B
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City | WILDWOOD
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State | MO
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Zip | 63040-1177
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Country | US
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Telephone | 618-235-8422
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 036.130265
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 2010019783
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License Number State | MO
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