Provider Demographics
NPI:1225002231
Name:NG, KENDRICK (DO)
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4733
Mailing Address - Country:US
Mailing Address - Phone:626-281-9111
Mailing Address - Fax:626-281-9499
Practice Address - Street 1:885 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4733
Practice Address - Country:US
Practice Address - Phone:626-281-9111
Practice Address - Fax:626-281-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8095207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX80950Medicaid
CAGR0101100Medicaid
CAH73632Medicare UPIN
CA20A8095AMedicare ID - Type UnspecifiedKENDRICK NG
CA00AX80950Medicaid
CAW19021Medicare ID - Type UnspecifiedKENDRICK NG A MEDICAL COR
CAW18775Medicare ID - Type UnspecifiedELITE DIAGNOSTIC AND MEDI