Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DDS104000 | CA |
Y | 213EG0000X | General Practice | DDS104000 | CA |
NPI | 1003469883 |
---|---|
Provider Name | Frankie C Ngo |
First Address | Los Angeles, CA 90032-3915 |
Second Address | Glendora, CA 91740-4122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2019 |
Last Update Date | 19/07/2019 |