Provider Demographics
NPI:1811207814
Name:NGO, KALIN THU (DDS)
Entity Type:Individual
Prefix:DR
First Name:KALIN
Middle Name:THU
Last Name:NGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9114 MCPHERSON RD
Mailing Address - Street 2:UNIT # 2201
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6473
Mailing Address - Country:US
Mailing Address - Phone:310-634-3764
Mailing Address - Fax:
Practice Address - Street 1:5300 SAN DARIO AVE
Practice Address - Street 2:C-2
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3000
Practice Address - Country:US
Practice Address - Phone:956-723-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-09
Last Update Date:2010-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice