Provider Demographics
NPI:1326461849
Name:NGO, VIVIENNE (DDS)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:
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 1:24953 PASEO DE VALENCIA STE 11C
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4344
Mailing Address - Country:US
Mailing Address - Phone:949-830-1395
Mailing Address - Fax:
Practice Address - Street 1:24953 PASEO DE VALENCIA STE 11C
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4344
Practice Address - Country:US
Practice Address - Phone:949-830-1395
Practice Address - Fax:949-830-7237
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist