Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401411494 | VA |
N | 1223E0200X | Endodontist | 13212 | MD |
N | 1223E0200X | Endodontist | 49162 | CA |
NPI | 1013923903 |
---|---|
Provider Name | Tu-Son Ngo |
First Address | Chantilly, VA 20151-4201 |
Second Address | Chantilly, VA 20151-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 17/09/2007 |