Healthcare Provider Details

I. General information

NPI: 1871607291
Provider Name (Legal Business Name): ROGER S ENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 JACKSON ST
SAN FRANCISCO CA
94133-4851
US

IV. Provider business mailing address

PO BOX 26750
FRESNO CA
93729-6750
US

V. Phone/Fax

Practice location:
  • Phone: 415-677-2320
  • Fax: 770-666-9102
Mailing address:
  • Phone: 559-455-4053
  • Fax: 770-666-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG75471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: