Provider Demographics
NPI:1558441980
Name:NG, CHRISTINE SIEW-PUN (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:SIEW-PUN
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 1:1361 13TH AVE S STE 180
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3235
Mailing Address - Country:US
Mailing Address - Phone:904-247-4300
Mailing Address - Fax:904-247-4350
Practice Address - Street 1:1361 13TH AVE S STE 180
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3235
Practice Address - Country:US
Practice Address - Phone:904-247-4300
Practice Address - Fax:904-247-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63182207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26805OtherBLUE CROSS BLUE SHIELD
FL28.589OtherAVMED
FL26805AMedicare ID - Type Unspecified
FLK3210Medicare PIN
FLA06720Medicare UPIN