MEDICARE: DR. KIM OANH NGO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	B42488	CA

General Provider Information

NPI Number	:	1215013834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM OANH NGO DDS

Provider Business Mailing Address
First Line	:	5058 UNION AVE
Second Line	:	SUITE A
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5454
Country	:	US
Telephone Number	:	408-559-8668
Fax Number	:	408-559-2022

Provider Business Practice Location Address
First Line	:	5058 UNION AVE
Second Line	:	SUITE A
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5454
Country	:	US
Telephone Number	:	408-559-8668
Fax Number	:	408-559-2022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/13/2008

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