Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 004506 | AZ |
Y | 213EG0000X | General Practice | 004506 | AZ |
NPI | 1003210881 |
---|---|
Provider Name | Thuy B Ngo |
First Address | Phoenix, AZ 85032 |
Second Address | Phoenix, AZ 85032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2014 |
Last Update Date | 22/10/2014 |