Provider Demographics
NPI:1477613339
Name:NGO, CHAU MINH (MD)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:MINH
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17357 LOS AMIGOS CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3921
Mailing Address - Country:US
Mailing Address - Phone:714-968-9862
Mailing Address - Fax:
Practice Address - Street 1:362 3RD ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2307
Practice Address - Country:US
Practice Address - Phone:949-494-0761
Practice Address - Fax:949-497-9922
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF57119Medicare UPIN