Provider Demographics
NPI:1467620682
Name:NG, DOUGLAS WING KEONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WING KEONG
Last Name:NG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 MEINECKE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-3706
Mailing Address - Country:US
Mailing Address - Phone:805-544-1246
Mailing Address - Fax:
Practice Address - Street 1:862 MEINECKE AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-3706
Practice Address - Country:US
Practice Address - Phone:805-544-1246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice