MEDICARE: JONATHAN K. ENG, MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A121799	CA

General Provider Information

NPI Number	:	1245664515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN K. ENG, MD, INC.

Provider Business Mailing Address
First Line	:	713 W DUARTE RD
Second Line	:	SUITE G-265
City	:	ARCADIA
State	:	CA
Zip	:	91007-7564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 W DUARTE RD
Second Line	:	SUITE G-265
City	:	ARCADIA
State	:	CA
Zip	:	91007-7564
Country	:	US
Telephone Number	:	626-281-5998
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN K ENG
Credential	:	MD
Telephone Number	:	626-380-7750

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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