Provider Demographics
NPI:1790148302
Name:NGO, BAO KHANG
Entity Type:Individual
Prefix:MR
First Name:BAO
Middle Name:KHANG
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 1:1891 LAUKAHI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1360
Mailing Address - Country:US
Mailing Address - Phone:808-688-8365
Mailing Address - Fax:808-626-3298
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 322
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5301
Practice Address - Country:US
Practice Address - Phone:808-688-8365
Practice Address - Fax:808-626-3298
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies