Provider Demographics
NPI:1174198113
Name:NG, KAREN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 KNOTT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5489
Mailing Address - Country:US
Mailing Address - Phone:800-219-9462
Mailing Address - Fax:800-219-9498
Practice Address - Street 1:11205 KNOTT AVE STE C
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5489
Practice Address - Country:US
Practice Address - Phone:800-219-9462
Practice Address - Fax:800-219-9498
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51028Medicaid