MEDICARE: KIM XUYEN THI NGO

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	101YM0800X	Mental Health Counselor	28254	CA

General Provider Information

NPI Number	:	1235402116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM XUYEN THI NGO

Provider Business Mailing Address
First Line	:	8251 WESTMINSTER BLVD STE 110
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3370
Country	:	US
Telephone Number	:	714-640-3430
Fax Number	:	714-620-7051

Provider Business Practice Location Address
First Line	:	8251 WESTMINSTER BLVD STE 110
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-3370
Country	:	US
Telephone Number	:	714-640-3430
Fax Number	:

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

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	09/18/2013

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Directions to “ KIM XUYEN THI NGO ” Practice Location

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