MEDICARE: CHAU MINH NGO M.D.

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	207R00000X	Internal Medicine Physician	G72718	CA

General Provider Information

NPI Number	:	1477613339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAU MINH NGO M.D.

Provider Business Mailing Address
First Line	:	17357 LOS AMIGOS CIR
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3921
Country	:	US
Telephone Number	:	714-968-9862
Fax Number	:

Provider Business Practice Location Address
First Line	:	362 3RD ST
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-2307
Country	:	US
Telephone Number	:	949-494-0761
Fax Number	:	949-497-9922

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	01/20/2015

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