Provider Demographics
NPI:1053448423
Name:TIEN THI MY NGO DDS INC
Entity Type:Organization
Organization Name:TIEN THI MY NGO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:THI MY
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-839-6631
Mailing Address - Street 1:10051 BOLSA AVE
Mailing Address - Street 2:# A1
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-839-6631
Mailing Address - Fax:714-839-2475
Practice Address - Street 1:10051 BOLSA AVE
Practice Address - Street 2:# A1
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-839-6631
Practice Address - Fax:714-839-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3714401Medicaid
CAB3714401Medicare ID - Type Unspecified
CAB3714401Medicaid