Provider Demographics
NPI:1003938101
Name:NGO, VAN NGOC (M,A,)
Entity Type:Individual
Prefix:MISS
First Name:VAN
Middle Name:NGOC
Last Name:NGO
Suffix:
Gender:F
Credentials:M,A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5842 E NAPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5039
Mailing Address - Country:US
Mailing Address - Phone:562-439-9539
Mailing Address - Fax:562-439-2232
Practice Address - Street 1:12914 HASTER ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-6517
Practice Address - Country:US
Practice Address - Phone:714-748-4327
Practice Address - Fax:562-439-2232
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1889231H00000X
CAHA3791237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU1889OtherAU LICENSE
HA3791OtherHEARING AID DISPENSER