Provider Demographics
NPI:1093379281
Name:NGO, AN MINH
Entity Type:Individual
Prefix:
First Name:AN
Middle Name:MINH
Last Name:NGO
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 1:124 DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3987
Mailing Address - Country:US
Mailing Address - Phone:650-572-2514
Mailing Address - Fax:650-572-2790
Practice Address - Street 1:124 DE ANZA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3987
Practice Address - Country:US
Practice Address - Phone:650-572-2514
Practice Address - Fax:650-572-2790
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist