1790892354 NPI number — DR. JAMES NGO MD

Table of content: DR. JAMES NGO MD (NPI 1790892354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790892354 NPI number — DR. JAMES NGO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGO
Provider First Name:
JAMES
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1790892354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44105 15TH ST W STE 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93534-4089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-949-5899
Provider Business Mailing Address Fax Number:
661-949-5832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44105 15TH ST W STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534-4089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-949-5899
Provider Business Practice Location Address Fax Number:
661-949-5832
Provider Enumeration Date:
08/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A94397 , 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: 00A943970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".