Provider Demographics
NPI:1649053653
Name:NGO, LONG QUANG
Entity type:Individual
Prefix:MR
First Name:LONG
Middle Name:QUANG
Last Name:NGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 W TOLEDO CIR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9098
Mailing Address - Country:US
Mailing Address - Phone:918-829-6882
Mailing Address - Fax:
Practice Address - Street 1:3004 W TOLEDO CIR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9098
Practice Address - Country:US
Practice Address - Phone:918-829-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program