Provider Demographics
NPI:1588636641
Name:NG, GAN XON (MD)
Entity Type:Individual
Prefix:
First Name:GAN
Middle Name:XON
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:SUITE 7501
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7417
Mailing Address - Country:US
Mailing Address - Phone:310-267-9643
Mailing Address - Fax:310-267-3840
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:SUITE 7501
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7417
Practice Address - Country:US
Practice Address - Phone:310-267-9643
Practice Address - Fax:310-267-3840
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY230318207R00000X
CAC53500208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588636641OtherCCS PANELED
CA1588636641Medicaid
CACM965XMedicare PIN
H96719Medicare UPIN
CA1588636641Medicaid