Provider Demographics
NPI:1295911915
Name:NGO, MADELEINE NGUYEN (MD)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:NGUYEN
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 JESLEW CT
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6840
Mailing Address - Country:US
Mailing Address - Phone:626-965-4871
Mailing Address - Fax:
Practice Address - Street 1:2236 JESLEW CT
Practice Address - Street 2:
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6840
Practice Address - Country:US
Practice Address - Phone:626-965-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34849208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine