Provider Demographics
NPI:1396323671
Name:NGO & PHAM DENTAL GROUP
Entity type:Organization
Organization Name:NGO & PHAM DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUNG
Authorized Official - Middle Name:SON
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-549-0878
Mailing Address - Street 1:502 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2118
Mailing Address - Country:US
Mailing Address - Phone:951-549-0878
Mailing Address - Fax:951-496-4011
Practice Address - Street 1:502 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2118
Practice Address - Country:US
Practice Address - Phone:951-549-0878
Practice Address - Fax:951-496-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831267053Medicaid
CA1689741159Medicaid