Provider Demographics
NPI:1477758167
Name:NGO, PHUONG LIEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:LIEN
Last Name:NGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JEFFERSON BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3387
Mailing Address - Country:US
Mailing Address - Phone:916-372-7022
Mailing Address - Fax:916-372-7226
Practice Address - Street 1:1001 JEFFERSON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3387
Practice Address - Country:US
Practice Address - Phone:916-372-7022
Practice Address - Fax:916-372-7226
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice