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General NPI Number Information
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NPI Number | 1972709558
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Entity Type | Organization
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Legal Business Name | HUONG-ANH NGO LONG, M.D., INC.
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1300 W 7TH ST
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City | SAN PEDRO
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State | CA
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Zip | 90732-3505
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Country | US
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Telephone | 310-514-5208
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Fax | 310-514-5374
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Provider Business Mailing Address
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Address Line | 1621 W 25TH ST #161
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City | SAN PEDRO
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State | CA
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Zip | 90732-4301
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Country | US
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Telephone | 310-514-5208
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Fax | 310-514-5374
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Authorized Official
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Title or Position | OWNER
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Name | DR. HUONG-ANH NGO LONG
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Credential | M.D.
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Telephone | 310-514-5208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G62453
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License Number State | CA
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