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General NPI Number Information
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NPI Number | 1770263907
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Entity Type | Individual
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Provider Name | KEVIN S NG
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Gender | Male
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 2800 OLYMPIC PKWY
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City | CHULA VISTA
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State | CA
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Zip | 91915-6002
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Country | US
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Telephone | 510-673-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 720 CAMINO DE LA REINA APT 214
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City | SAN DIEGO
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State | CA
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Zip | 92108-3228
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Country | US
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Telephone | 510-673-5433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | CA
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