Healthcare Provider Details

I. General information

NPI: 1669502225
Provider Name (Legal Business Name): EATON CANYON PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD SUITE NUMBER 360
PASADENA CA
91107-1448
US

IV. Provider business mailing address

2750 E WASHINGTON BLVD SUITE NUMBER 360
PASADENA CA
91107-1448
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-8098
  • Fax: 626-794-6723
Mailing address:
  • Phone: 626-794-8098
  • Fax: 626-794-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC28806
License Number StateCA

VIII. Authorized Official

Name: DR. LIONEL P NG
Title or Position: PRESIDENT
Credential: M. D.
Phone: 626-794-8098