Provider Demographics
NPI:1174055149
Name:NGO, DALLIS QUANG (DO, MS)
Entity type:Individual
Prefix:DR
First Name:DALLIS
Middle Name:QUANG
Last Name:NGO
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
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Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:
Practice Address - Street 1:1940 N ORANGE GROVE AVE STE A
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3002
Practice Address - Country:US
Practice Address - Phone:909-865-6900
Practice Address - Fax:909-865-6300
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022013108390200000X
CA20A16871207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program