Healthcare Provider Details

I. General information

NPI: 1659309789
Provider Name (Legal Business Name): PHILIP K NG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD.
LOS ANGELES CA
90048-1865
US

IV. Provider business mailing address

PO BOX 512717
LOS ANGELES CA
90051-0717
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-1884
  • Fax: 310-967-1744
Mailing address:
  • Phone: 310-967-1884
  • Fax: 310-967-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG71446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG71446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: