Active NPI
Justin D Ngo, DMD
- Dentist
- Philadelphia, PA
National Provider Identifier
1700306180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS041243
- Practice address
- 2107 Cottman Ave
Philadelphia, PA 19149-1122 - Phone
- (215) 235-4060
- NPI assigned
- Jun 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS041243 | PA | Primary |
Addresses
Primary practice location
2107 Cottman Ave
Philadelphia, PA 19149-1122
Mailing address
2958 Willow Street Pike N
Willow Street, PA 17584-9489
Phone (717) 917-0147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170807001667 | PA | Order and Referring Only - Dentist | 6507137791 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS041243 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498435200000",
"number": "1700306180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2958 WILLOW STREET PIKE N",
"city": "WILLOW STREET",
"state": "PA",
"postal_code": "175849489",
"telephone_number": "717-917-0147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2107 COTTMAN AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191491122",
"telephone_number": "215-235-4060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGO",
"first_name": "JUSTIN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-26",
"last_updated": "2017-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS041243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.