Provider Demographics
NPI:1043269145
Name:PHAN, NGO C (MD)
Entity type:Individual
Prefix:DR
First Name:NGO
Middle Name:C
Last Name:PHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 W VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803
Mailing Address - Country:US
Mailing Address - Phone:626-281-3265
Mailing Address - Fax:626-281-3267
Practice Address - Street 1:2835 W VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803
Practice Address - Country:US
Practice Address - Phone:626-281-3265
Practice Address - Fax:626-281-3267
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A640440Medicaid
CAH08703Medicare UPIN
CA00A640440Medicaid