1912032392 NPI number — DR. UYEN THANH NGO OD

Table of content: DR. UYEN THANH NGO OD (NPI 1912032392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912032392 NPI number — DR. UYEN THANH NGO OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGO
Provider First Name:
UYEN
Provider Middle Name:
THANH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGO
Provider Other First Name:
TARRRYN
Provider Other Middle Name:
UYEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912032392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 N CAPITOL AVE
Provider Second Line Business Mailing Address:
STE 180
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95132-2570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-272-4446
Provider Business Mailing Address Fax Number:
408-272-5324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 N CAPITOL AVE
Provider Second Line Business Practice Location Address:
STE 180
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95132-2570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-272-4446
Provider Business Practice Location Address Fax Number:
408-272-5324
Provider Enumeration Date:
02/23/2007

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: 152W00000X , with the licence number:  10814T , 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: SD0108140 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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