Provider Demographics
NPI:1750321899
Name:NGO, QUAN (PT)
Entity type:Individual
Prefix:MR
First Name:QUAN
Middle Name:
Last Name:NGO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 E ORANGETHORPE AVE
Mailing Address - Street 2:STE 180
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5205
Mailing Address - Country:US
Mailing Address - Phone:714-823-4400
Mailing Address - Fax:714-823-4404
Practice Address - Street 1:16405 WHITTIER BLVD
Practice Address - Street 2:ATTENTION JODY LANE
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-3044
Practice Address - Country:US
Practice Address - Phone:562-501-2200
Practice Address - Fax:562-501-2206
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT22690OtherPT LICENSE