Provider Demographics
NPI:1558308106
Name:NGO, TAM THI (MD)
Entity type:Individual
Prefix:MRS
First Name:TAM
Middle Name:THI
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 WEST FIRST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703
Mailing Address - Country:US
Mailing Address - Phone:714-550-0853
Mailing Address - Fax:714-550-0854
Practice Address - Street 1:2509 WEST FIRST ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703
Practice Address - Country:US
Practice Address - Phone:714-550-0853
Practice Address - Fax:714-550-0854
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA366702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A366700Medicaid
A36670Medicare ID - Type Unspecified
C35468Medicare UPIN