MEDICARE: MAI DUYEN 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	183500000X	Pharmacist	39723	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N1881792638	OTHER	TX	NPI
2	W112590872	OTHER	TX	AETNA INSURANCE

General Provider Information

NPI Number	:	1992309009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI DUYEN NGO

Provider Business Mailing Address
First Line	:	9721 BIRDVILLE WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6299
Country	:	US
Telephone Number	:	817-689-4653
Fax Number	:

Provider Business Practice Location Address
First Line	:	9721 BIRDVILLE WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6299
Country	:	US
Telephone Number	:	817-689-4653
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ MAI DUYEN NGO ” Practice Location

Language	Start Address	Practice Location

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