Provider Demographics
NPI:1427200427
Name:NGO, KIET XUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIET
Middle Name:XUAN
Last Name:NGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E LAS TUNAS DR
Mailing Address - Street 2:SUITE #204
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1535
Mailing Address - Country:US
Mailing Address - Phone:626-292-7233
Mailing Address - Fax:626-292-7238
Practice Address - Street 1:316 E LAS TUNAS DR
Practice Address - Street 2:SUITE #204
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1535
Practice Address - Country:US
Practice Address - Phone:626-292-7233
Practice Address - Fax:626-292-7238
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist