Provider Demographics
NPI:1598314742
Name:NGO, TAN
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:
Last Name:NGO
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 1:3025 N TARRANT PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8625
Mailing Address - Country:US
Mailing Address - Phone:817-697-3900
Mailing Address - Fax:866-741-2679
Practice Address - Street 1:3025 N TARRANT PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8625
Practice Address - Country:US
Practice Address - Phone:817-972-3900
Practice Address - Fax:866-741-2679
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical