Provider Demographics
NPI:1952061301
Name:NGO, JENNIFER SAGUN (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SAGUN
Last Name:NGO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 W 235TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4223
Mailing Address - Country:US
Mailing Address - Phone:209-483-7387
Mailing Address - Fax:
Practice Address - Street 1:1526 N EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001637367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered