Provider Demographics
NPI:1366465965
Name:NGO, KHIET (DO)
Entity Type:Individual
Prefix:
First Name:KHIET
Middle Name:
Last Name:NGO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E CAROLINE ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3747
Mailing Address - Country:US
Mailing Address - Phone:909-651-1903
Mailing Address - Fax:
Practice Address - Street 1:250 E CAROLINE ST
Practice Address - Street 2:SUITE J
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3747
Practice Address - Country:US
Practice Address - Phone:909-651-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A77882080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX77880Medicaid
CA00AX77880Medicaid
H60688Medicare UPIN