Provider Demographics
NPI:1235274820
Name:NGO, PHUONG MY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:MY
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 1:1318 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5118
Mailing Address - Country:US
Mailing Address - Phone:714-952-3582
Mailing Address - Fax:714-952-3583
Practice Address - Street 1:1318 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5118
Practice Address - Country:US
Practice Address - Phone:714-952-3582
Practice Address - Fax:714-952-3583
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41493Medicare ID - Type UnspecifiedDENTI-CAL