Provider Demographics
NPI:1750052270
Name:NGO, LILLIANA QUYNH
Entity Type:Individual
Prefix:
First Name:LILLIANA
Middle Name:QUYNH
Last Name:NGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7001
Mailing Address - Country:US
Mailing Address - Phone:714-725-0340
Mailing Address - Fax:
Practice Address - Street 1:837 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5413
Practice Address - Country:US
Practice Address - Phone:626-962-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist