Provider Demographics
NPI:1083917504
Name:NG, KATHY H (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:H
Last Name:NG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 41ST AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2057
Mailing Address - Country:US
Mailing Address - Phone:831-476-7744
Mailing Address - Fax:
Practice Address - Street 1:2121 41ST AVE STE 108
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2057
Practice Address - Country:US
Practice Address - Phone:831-476-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist