Provider Demographics
NPI:1407233745
Name:KHA H. NGO, D.O., P.L.L.C.
Entity Type:Organization
Organization Name:KHA H. NGO, D.O., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-662-4110
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:STE 350
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-662-4110
Mailing Address - Fax:248-662-4120
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:STE 350
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-662-4110
Practice Address - Fax:248-662-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017406207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty