Provider Demographics
NPI:1225212798
Name:MICHAEL Q NGO
Entity Type:Organization
Organization Name:MICHAEL Q NGO
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVELINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-680-3377
Mailing Address - Street 1:1332 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3954
Mailing Address - Country:US
Mailing Address - Phone:714-680-3377
Mailing Address - Fax:714-680-0098
Practice Address - Street 1:1332 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3954
Practice Address - Country:US
Practice Address - Phone:714-680-3377
Practice Address - Fax:714-680-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty