Provider Demographics
NPI:1508426420
Name:KUONG NGANN DO CORP
Entity Type:Organization
Organization Name:KUONG NGANN DO CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:831-755-4196
Mailing Address - Street 1:35 E GLENARM ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3418
Mailing Address - Country:US
Mailing Address - Phone:626-768-4415
Mailing Address - Fax:626-403-0321
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-755-4111
Practice Address - Fax:626-403-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12099OtherCA LICENSE