Healthcare Provider Details

I. General information

NPI: 1265562466
Provider Name (Legal Business Name): THEODORE NG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LAKESHORE DR
SAN FRANCISCO CA
94132-1118
US

IV. Provider business mailing address

131 LAKESHORE DR
SAN FRANCISCO CA
94132-1118
US

V. Phone/Fax

Practice location:
  • Phone: 510-326-7193
  • Fax: 510-271-0656
Mailing address:
  • Phone: 510-326-7193
  • Fax: 510-271-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number37713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: