Provider Demographics
NPI:1417075946
Name:NG FAMILY PRACTICE CLINIC PC
Entity Type:Organization
Organization Name:NG FAMILY PRACTICE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUN-HO
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-933-1282
Mailing Address - Street 1:302 N CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3823
Mailing Address - Country:US
Mailing Address - Phone:704-933-2128
Mailing Address - Fax:704-644-2547
Practice Address - Street 1:302 N CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3823
Practice Address - Country:US
Practice Address - Phone:704-933-2128
Practice Address - Fax:704-644-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28083261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center