MEDICARE: MRS. CHRISTINE SIEW-PUN NG MD

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	207N00000X	Dermatology Physician	ME63182	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26805	OTHER	FL	BLUE CROSS BLUE SHIELD
2	28.589	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1558441980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE SIEW-PUN NG MD

Provider Business Mailing Address
First Line	:	1361 13TH AVE S STE 180
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3235
Country	:	US
Telephone Number	:	904-247-4300
Fax Number	:	904-247-4350

Provider Business Practice Location Address
First Line	:	1361 13TH AVE S STE 180
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3235
Country	:	US
Telephone Number	:	904-247-4300
Fax Number	:	904-247-4350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	02/13/2008

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