Provider Demographics
NPI:1932674512
Name:NGO, JENNY BAO NGAN XUAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNY BAO NGAN
Middle Name:XUAN
Last Name:NGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1540 FOG BANK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-1756
Mailing Address - Country:US
Mailing Address - Phone:408-234-7750
Mailing Address - Fax:408-516-1028
Practice Address - Street 1:1950 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-5190
Practice Address - Country:US
Practice Address - Phone:800-464-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76996183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100143823Medicaid