Provider Demographics
NPI:1578937363
Name:NGOV, RYAN KYHEANG
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KYHEANG
Last Name:NGOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 ALPINE CIR
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5667
Mailing Address - Country:US
Mailing Address - Phone:213-249-6583
Mailing Address - Fax:
Practice Address - Street 1:7300 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-3738
Practice Address - Country:US
Practice Address - Phone:323-583-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist