Provider Demographics
NPI:1215013834
Name:NGO, KIM OANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:OANH
Last Name:NGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 UNION AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5454
Mailing Address - Country:US
Mailing Address - Phone:408-559-8668
Mailing Address - Fax:408-559-2022
Practice Address - Street 1:5058 UNION AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5454
Practice Address - Country:US
Practice Address - Phone:408-559-8668
Practice Address - Fax:408-559-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB424881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice