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NPI Code Detail

MEDICARE: MR. DERRICK WING NING NG RN

MEDICARE:  MR. DERRICK WING NING NG  RN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95016233CA
2163WP0808XPsychiatric/Mental Health Registered Nurse658357CA

General Provider Information

NPI Number : 1730332719
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DERRICK WING NING NG RN
Provider Business Mailing Address
First Line : 3652 PRIMAVERA AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90065-3312
Country : US
Telephone Number : 323-229-5993
Fax Number :
Provider Business Practice Location Address
First Line : 450 BAUCHET ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90012-2907
Country : US
Telephone Number : 213-893-5392
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2008
Last Update Date : 03/26/2025

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