Provider Demographics
NPI:1346535572
Name:NGO, REGINA TRAN (DMD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:TRAN
Last Name:NGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 BOUNTY DR
Mailing Address - Street 2:APT #102
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-4130
Mailing Address - Country:US
Mailing Address - Phone:602-326-3521
Mailing Address - Fax:
Practice Address - Street 1:633 BOUNTY DR
Practice Address - Street 2:APT #102
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-4130
Practice Address - Country:US
Practice Address - Phone:602-326-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice