MEDICARE: DAVID C. NG, DPM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E4111	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000E41111	OTHER	CA	BLUE SHIELD PROVIDER ID #

General Provider Information

NPI Number	:	1730247057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID C. NG, DPM, INC.

Provider Business Mailing Address
First Line	:	13960 BLACK ROCK CIR
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-5025
Country	:	US
Telephone Number	:	805-497-7822
Fax Number	:	805-293-6768

Provider Business Practice Location Address
First Line	:	123 HODENCAMP RD STE 101
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5833
Country	:	US
Telephone Number	:	805-497-7822
Fax Number	:	805-293-6768

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID CHANG NG
Credential	:	DPM
Telephone Number	:	805-497-7822

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	01/09/2023

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