Provider Demographics
NPI:1215115811
Name:NGO, HUNG QUOC (MD)
Entity type:Individual
Prefix:MR
First Name:HUNG
Middle Name:QUOC
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX: 1515
Mailing Address - Street 2:
Mailing Address - City:WINDEMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786
Mailing Address - Country:US
Mailing Address - Phone:407-412-5936
Mailing Address - Fax:407-601-0413
Practice Address - Street 1:54 S. KIRKMAN ROAD
Practice Address - Street 2:SUITE: E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811
Practice Address - Country:US
Practice Address - Phone:407-412-5936
Practice Address - Fax:407-601-0413
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000196400Medicaid
FLAK951AMedicare PIN
FLDA626AMedicare PIN
FLAK951ZMedicare PIN