Provider Demographics
NPI:1366613457
Name:NGO, THIENKIM VU (MD)
Entity type:Individual
Prefix:
First Name:THIENKIM
Middle Name:VU
Last Name:NGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:VU
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3626 RUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1810
Mailing Address - Country:US
Mailing Address - Phone:858-565-9666
Mailing Address - Fax:858-565-9441
Practice Address - Street 1:3626 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1810
Practice Address - Country:US
Practice Address - Phone:858-565-9666
Practice Address - Fax:858-565-9441
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102050207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB240013Medicare PIN