Provider Demographics
NPI:1376699512
Name:NGO, JAMIE ANHTHAO (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANHTHAO
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ELDRIDGE RD.
Mailing Address - Street 2:UNIT D.
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:832-939-8956
Mailing Address - Fax:832-930-4748
Practice Address - Street 1:126 ELDRIDGE RD
Practice Address - Street 2:UNIT D
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:832-939-8956
Practice Address - Fax:832-930-4748
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178542001Medicaid
TX23002Medicare UPIN