Provider Demographics
NPI:1033137690
Name:NGO, HOAN LIEN (DC)
Entity Type:Individual
Prefix:DR
First Name:HOAN
Middle Name:LIEN
Last Name:NGO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-4507
Mailing Address - Country:US
Mailing Address - Phone:510-534-2388
Mailing Address - Fax:510-868-9329
Practice Address - Street 1:4514 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-4507
Practice Address - Country:US
Practice Address - Phone:510-534-2388
Practice Address - Fax:510-868-9329
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0284060Medicare UPIN