Provider Demographics
NPI:1144385766
Name:HY PHUNG NGO MD INC
Entity Type:Organization
Organization Name:HY PHUNG NGO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HY
Authorized Official - Middle Name:PHUNG
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-572-4658
Mailing Address - Street 1:625 E VALLEY BLVD
Mailing Address - Street 2:SUITE H&I
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3591
Mailing Address - Country:US
Mailing Address - Phone:626-572-4658
Mailing Address - Fax:626-572-4659
Practice Address - Street 1:625 E VALLEY BLVD
Practice Address - Street 2:SUITE H&I
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3591
Practice Address - Country:US
Practice Address - Phone:626-572-4658
Practice Address - Fax:626-572-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697360Medicaid
CAH44051Medicare UPIN
CAW16433Medicare PIN