Provider Demographics
NPI:1437247384
Name:NG, REGINA (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 STOCKDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2150
Mailing Address - Country:US
Mailing Address - Phone:877-524-7373
Mailing Address - Fax:
Practice Address - Street 1:3501 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2150
Practice Address - Country:US
Practice Address - Phone:877-524-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADEABN7485647207R00000X
CAA75280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092950OtherMEDI-CAL GROUP PROV #
CAZZZ01707ZOtherMEDICARE GROUP PTAN
CAZZZ01800ZOtherBLUE SHIELD GROUP PROV#
CAZZZ01800ZOtherBLUE SHIELD GROUP PROV#
CA00A752801Medicare PIN