Provider Demographics
NPI:1659869337
Name:NGO, NINA (DO)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 CREEKSIDE LOOP STE 125
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4858
Mailing Address - Country:US
Mailing Address - Phone:509-240-9660
Mailing Address - Fax:218-217-4231
Practice Address - Street 1:3908 CREEKSIDE LOOP STE 125
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4858
Practice Address - Country:US
Practice Address - Phone:509-240-9660
Practice Address - Fax:218-217-4231
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10064993390200000X
WAOP61171964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOP61171964OtherWA STATE MEDICAL BOARD