1144385766 NPI number — HY PHUNG NGO MD INC

Table of content: (NPI 1144385766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144385766 NPI number — HY PHUNG NGO MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HY PHUNG NGO MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144385766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 E VALLEY BLVD
Provider Second Line Business Mailing Address:
SUITE H&I
Provider Business Mailing Address City Name:
SAN GABRIEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91776-3591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-572-4658
Provider Business Mailing Address Fax Number:
626-572-4659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 E VALLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE H&I
Provider Business Practice Location Address City Name:
SAN GABRIEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91776-3591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-572-4658
Provider Business Practice Location Address Fax Number:
626-572-4659
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGO
Authorized Official First Name:
HY
Authorized Official Middle Name:
PHUNG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-572-4658

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A69736 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A697360 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com