Provider Demographics
NPI:1336554542
Name:KATHY VU NGO, PLLC
Entity type:Organization
Organization Name:KATHY VU NGO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-733-4797
Mailing Address - Street 1:11851 N 51ST AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2809
Mailing Address - Country:US
Mailing Address - Phone:623-414-6476
Mailing Address - Fax:
Practice Address - Street 1:11851 N 51ST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2809
Practice Address - Country:US
Practice Address - Phone:623-414-6476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty