Provider Demographics
NPI:1285760850
Name:NGO, CUONG VIET (MD)
Entity type:Individual
Prefix:DR
First Name:CUONG
Middle Name:VIET
Last Name:NGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:VIET
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2142 W CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2490
Mailing Address - Country:US
Mailing Address - Phone:714-758-1837
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3953
Practice Address - Country:US
Practice Address - Phone:714-899-3498
Practice Address - Fax:714-899-3493
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF40157Medicare UPIN