Provider Demographics
NPI:1467824458
Name:DO, NGOC (LAC, DAOM)
Entity Type:Individual
Prefix:
First Name:NGOC
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 STORY ROAD
Mailing Address - Street 2:UNIT 7024
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4617
Mailing Address - Country:US
Mailing Address - Phone:669-888-6979
Mailing Address - Fax:
Practice Address - Street 1:979 STORY ROAD
Practice Address - Street 2:UNIT 7024
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4617
Practice Address - Country:US
Practice Address - Phone:669-888-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053856484OtherOTHER