Provider Demographics
NPI:1508990664
Name:DEAN BA NGO MD INC
Entity Type:Organization
Organization Name:DEAN BA NGO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-531-0000
Mailing Address - Street 1:6426 FAIRWIND CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6714
Mailing Address - Country:US
Mailing Address - Phone:714-556-0000
Mailing Address - Fax:714-556-1006
Practice Address - Street 1:15606 BROOKHURST ST STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7582
Practice Address - Country:US
Practice Address - Phone:714-531-0000
Practice Address - Fax:714-531-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50341207Q00000X
CAA60674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60674OtherLICENSE
CA00A606740Medicaid
CAG97109Medicare UPIN
CAW21354Medicare PIN