Provider Demographics
NPI:1164612156
Name:NG, DARREN JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:JONATHAN
Last Name:NG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SAN PABLO AVE
Mailing Address - Street 2:SUITE B5
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 SAN PABLO AVE
Practice Address - Street 2:SUITE B5
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-3968
Practice Address - Country:US
Practice Address - Phone:510-741-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13319T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist