Provider Demographics
NPI:1972709558
Name:HUONG-ANH NGO LONG, M.D., INC.
Entity type:Organization
Organization Name:HUONG-ANH NGO LONG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUONG-ANH
Authorized Official - Middle Name:NGO
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-514-5208
Mailing Address - Street 1:1621 W 25TH ST
Mailing Address - Street 2:#161
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4301
Mailing Address - Country:US
Mailing Address - Phone:310-514-5208
Mailing Address - Fax:310-514-5374
Practice Address - Street 1:1300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3505
Practice Address - Country:US
Practice Address - Phone:310-514-5208
Practice Address - Fax:310-514-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62453208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14271Medicare ID - Type UnspecifiedPROVIDER IDENTIFIED