Ngo & Pham Dental Group

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

NGO & PHAM DENTAL GROUP

Practice address

502 W Grand Blvd
Corona, CA 92882-2118

Phone

(951) 549-0878

Fax

(951) 496-4011

NPI assigned

Mar 30, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tung Son Ngo, DDSNPI 1689741159

Title

Owner

Phone

(951) 549-0878

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Grand Smile Care Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tung Son Ngo, DDS

  • General Practice Dentistry
  • Anaheim, CA
  • NPI 1689741159
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617062400000",
    "number": "1396323671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 W GRAND BLVD",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822118",
            "telephone_number": "951-549-0878",
            "fax_number": "951-496-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W GRAND BLVD",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822118",
            "telephone_number": "951-549-0878",
            "fax_number": "951-496-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NGO & PHAM DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2021-03-30",
        "certification_date": "2021-02-12",
        "status": "A",
        "authorized_official_last_name": "NGO",
        "authorized_official_first_name": "TUNG",
        "authorized_official_middle_name": "SON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-549-0878",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831267053",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689741159",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Smile Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Michelle Newkirk-Stone
• Nicole Rae Newman, PA-C
• Travis D. Newton, D.C.
• Nexus Hospice of Riverside, LLC
• Noelani Neyra
• Dominique Ngo Bassong
• Katie T Ngo, D.D.S.
• Thong Anh Ngo, DO
• Lilian Wambui Ngure
• Nguyen & Truong Dental Corp.

• Clinic/Center in Corona, CA
• Providers in Corona, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.