MEDICARE: RAYMOND THANH 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	1223G0001X	General Practice Dentistry	108261	CA
2	1223G0001X	General Practice Dentistry	37225	TX

General Provider Information

NPI Number	:	1801462403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND THANH NGO

Provider Business Mailing Address
First Line	:	2020 CASSIA RD STE 102
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-4211
Country	:	US
Telephone Number	:	760-918-0798
Fax Number	:	442-244-0580

Provider Business Practice Location Address
First Line	:	2020 CASSIA RD STE 102
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-4211
Country	:	US
Telephone Number	:	760-918-0798
Fax Number	:	442-244-0580

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	10/06/2025

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Directions to “ RAYMOND THANH NGO ” Practice Location

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