Provider Demographics
NPI:1588160253
Name:NGO, JENNIFER PHUONG-VY (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PHUONG-VY
Last Name:NGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14305 MERIDIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:MARCH AIR RESERVE BASE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-3034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14305 MERIDIAN PKWY
Practice Address - Street 2:
Practice Address - City:MARCH AIR RESERVE BASE
Practice Address - State:CA
Practice Address - Zip Code:92518-3034
Practice Address - Country:US
Practice Address - Phone:951-251-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17958207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine