Provider Demographics
NPI:1508338799
Name:NGO, HONG-AN PHUC (DO)
Entity Type:Individual
Prefix:
First Name:HONG-AN
Middle Name:PHUC
Last Name:NGO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 52ND AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2354
Mailing Address - Country:US
Mailing Address - Phone:206-414-2354
Mailing Address - Fax:
Practice Address - Street 1:15215 52ND AVE S STE 204
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2354
Practice Address - Country:US
Practice Address - Phone:206-414-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61440786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty