Provider Demographics
NPI:1104045541
Name:NGO, TRUNG T (MD)
Entity Type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:T
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1355 FLORIN RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4231
Mailing Address - Country:US
Mailing Address - Phone:916-706-2300
Mailing Address - Fax:916-706-2224
Practice Address - Street 1:1355 FLORIN RD
Practice Address - Street 2:STE 12
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4231
Practice Address - Country:US
Practice Address - Phone:916-706-2300
Practice Address - Fax:916-706-2224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA372752085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV124AMedicare PIN