Provider Demographics
NPI:1821371444
Name:NGO, HAIDUONG
Entity Type:Individual
Prefix:DR
First Name:HAIDUONG
Middle Name:
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 1:19652 WATERBURY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3547
Mailing Address - Country:US
Mailing Address - Phone:714-378-8684
Mailing Address - Fax:714-378-8684
Practice Address - Street 1:191 E YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3328
Practice Address - Country:US
Practice Address - Phone:714-854-1767
Practice Address - Fax:714-854-0903
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA54675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist