MEDICARE: GAN XON 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	207R00000X	Internal Medicine Physician	230318	NY
2	208M00000X	Hospitalist Physician	C53500	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588636641	OTHER	CA	CCS PANELED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588636641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAN XON NG MD

Provider Business Mailing Address
First Line	:	757 WESTWOOD PLZ
Second Line	:	SUITE 7501
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7417
Country	:	US
Telephone Number	:	310-267-9643
Fax Number	:	310-267-3840

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ
Second Line	:	SUITE 7501
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7417
Country	:	US
Telephone Number	:	310-267-9643
Fax Number	:	310-267-3840

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	03/28/2017

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