Provider Demographics
NPI:1467503953
Name:NG, WHITNEY D (OD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:D
Last Name:NG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 EL CAMINO REAL
Mailing Address - Street 2:STE 160
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4847
Mailing Address - Country:US
Mailing Address - Phone:650-329-8182
Mailing Address - Fax:650-329-1069
Practice Address - Street 1:4950 PACIFIC AVE
Practice Address - Street 2:WEBERSTOWN SHOPPING CTR
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6307
Practice Address - Country:US
Practice Address - Phone:209-477-4114
Practice Address - Fax:209-477-9871
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11712152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0117120Medicare ID - Type Unspecified