Provider Demographics
NPI:1518413004
Name:NG, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 HOLLYWOOD BLVD STE 126
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-5363
Mailing Address - Country:US
Mailing Address - Phone:323-467-7954
Mailing Address - Fax:
Practice Address - Street 1:6201 HOLLYWOOD BLVD STE 126
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-5363
Practice Address - Country:US
Practice Address - Phone:323-467-7954
Practice Address - Fax:323-284-7575
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist