Provider Demographics
NPI:1356493316
Name:NG, DEAN G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:G
Last Name:NG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2126
Mailing Address - Country:US
Mailing Address - Phone:323-662-1139
Mailing Address - Fax:323-663-1223
Practice Address - Street 1:2860 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2126
Practice Address - Country:US
Practice Address - Phone:323-662-1139
Practice Address - Fax:323-663-1223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 27862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA196270Medicaid