Provider Demographics
NPI:1649374638
Name:NGO, ANH THIEN (MD)
Entity type:Individual
Prefix:DR
First Name:ANH
Middle Name:THIEN
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 S. BEACH BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-879-4963
Mailing Address - Fax:714-821-8905
Practice Address - Street 1:480 S. BEACH BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-879-4963
Practice Address - Fax:714-821-8905
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74933207VG0400X
CAA054744207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14786Medicare ID - Type Unspecified
A54744Medicare UPIN