Healthcare Provider Details

I. General information

NPI: 1285830737
Provider Name (Legal Business Name): MATTHEW ELLIOT NG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 BAKER ST STE H1
COSTA MESA CA
92626-4165
US

IV. Provider business mailing address

1170 BAKER ST STE H1
COSTA MESA CA
92626-4165
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-3250
  • Fax: 949-791-3251
Mailing address:
  • Phone: 949-791-3250
  • Fax: 949-791-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA108266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: