Provider Demographics
NPI:1871658492
Name:NGO, HY PHUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:HY
Middle Name:PHUNG
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 1:625 E VALLEY BLVD
Mailing Address - Street 2:SUITE H,I& G
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3591
Mailing Address - Country:US
Mailing Address - Phone:626-572-4658
Mailing Address - Fax:626-572-4659
Practice Address - Street 1:625 E VALLEY BLVD
Practice Address - Street 2:SUITE H&I
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3591
Practice Address - Country:US
Practice Address - Phone:626-572-4658
Practice Address - Fax:626-572-4659
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A697360Medicaid
CA00A697360Medicaid
CAWA69736AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER