MEDICARE: NGA HONG NGO DDS

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	58595	CA

General Provider Information

NPI Number	:	1922331172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGA HONG NGO DDS

Provider Business Mailing Address
First Line	:	5058 UNION AVE # A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5432
Country	:	US
Telephone Number	:	408-559-8668
Fax Number	:	408-559-2022

Provider Business Practice Location Address
First Line	:	5058 UNION AVE # A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5432
Country	:	US
Telephone Number	:	408-559-8668
Fax Number	:	408-559-2022

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

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/04/2009

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