=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760625339
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID P NG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2009
-----------------------------------------------------
Last Update Date | 12/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 551 N 34TH ST STE 100
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-8675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-374-9000
-----------------------------------------------------
Fax | 206-374-9009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S CHIPETA WAY # 115G-04
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84108-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-583-2787
-----------------------------------------------------
Fax | 801-584-5124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Pathology) Physician
-----------------------------------------------------
License Number | MD 60318170
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | MD 60318170
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------