Basic Information
| Provider Information | |||||||||
| NPI: | 1598314742 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NGO | ||||||||
| FirstName: | TAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 N TARRANT PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761778625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176973900 | ||||||||
| FaxNumber: | 8667412679 | ||||||||
| Practice Location | |||||||||
| Address1: | 3025 N TARRANT PKWY STE 140 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761778625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179723900 | ||||||||
| FaxNumber: | 8667412679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.