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NPI Code Detail

MEDICARE: DR. PHAT NGO MD

MEDICARE: DR. PHAT NGO MD
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
1207R00000XInternal Medicine PhysicianA76909CA

General Provider Information

NPI Number : 1619938305
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHAT NGO MD
Provider Business Mailing Address
First Line : 11201 BENTON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92357-1000
Country : US
Telephone Number : 909-825-7084
Fax Number :
Provider Business Practice Location Address
First Line : 11201 BENTON ST
Second Line :
City : LOMA LINDA
State : CA
Zip : 92357-1000
Country : US
Telephone Number : 909-825-7084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 03/29/2010

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Directions to “ DR. PHAT NGO MD” Practice Location

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