Basic Information
| Provider Information | |||||||||
| NPI: | 1740294735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGO | ||||||||
| FirstName: | HUNG | ||||||||
| MiddleName: | THE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | R.PH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 NORTH MAIN STREET | ||||||||
| Address2: | APT.6 | ||||||||
| City: | LANSING | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
| FaxNumber: | 9137584109 | ||||||||
| Practice Location | |||||||||
| Address1: | 4101 S. 4TH STREET TRAFFICWAY | ||||||||
| Address2: | DWIGHT D EISENHOWER MEDICAL CENTER | ||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660489951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
| FaxNumber: | 9137584109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 14050 | NV | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.