Provider Demographics
NPI:1043865751
Name:HO, NGOC ANH THU
Entity Type:Individual
Prefix:
First Name:NGOC ANH THU
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W LOWDEN ST APT 15
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2810
Mailing Address - Country:US
Mailing Address - Phone:682-402-8190
Mailing Address - Fax:
Practice Address - Street 1:2200 W LOWDEN ST APT 15
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2810
Practice Address - Country:US
Practice Address - Phone:682-402-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered