Provider Demographics
NPI:1770503997
Name:NGO, TAN DINH (MD)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:DINH
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9431 EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7425
Mailing Address - Country:US
Mailing Address - Phone:714-839-8400
Mailing Address - Fax:714-839-8230
Practice Address - Street 1:9431 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7425
Practice Address - Country:US
Practice Address - Phone:714-839-8400
Practice Address - Fax:714-839-8230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75839L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F89576Medicare UPIN
WG75839LMedicare ID - Type Unspecified