Provider Demographics
NPI:1538974712
Name:NGO, QUAN A (LEP)
Entity type:Individual
Prefix:DR
First Name:QUAN
Middle Name:A
Last Name:NGO
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 N STAR CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1981
Mailing Address - Country:US
Mailing Address - Phone:408-890-1341
Mailing Address - Fax:
Practice Address - Street 1:520 MORNING GLORY CT
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5583
Practice Address - Country:US
Practice Address - Phone:484-985-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4023103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool