MEDICARE: MR. THANH HUU NGO D.D.S.

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	47138	CA

General Provider Information

NPI Number	:	1699844068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THANH HUU NGO D.D.S.

Provider Business Mailing Address
First Line	:	6413 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4022
Country	:	US
Telephone Number	:	562-938-8388
Fax Number	:	562-938-8389

Provider Business Practice Location Address
First Line	:	6413 E SPRING ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-4022
Country	:	US
Telephone Number	:	562-938-8388
Fax Number	:	562-938-8389

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	05/25/2012

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