Healthcare Provider Details

I. General information

NPI: 1811424575
Provider Name (Legal Business Name): CHRISTOPHER NG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 06/28/2020
Certification Date: 06/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13625 RONALD W REAGAN BLVD BLDG 6
CEDAR PARK TX
78613-2073
US

IV. Provider business mailing address

4900 MUELLER BLVD SUITE 3S.066C
AUSTIN TX
78723-3079
US

V. Phone/Fax

Practice location:
  • Phone: 512-336-2777
  • Fax:
Mailing address:
  • Phone: 512-324-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10059352
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: