Provider Demographics
NPI:1619461365
Name:NG, JOSHUA (NP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1114
Mailing Address - Country:US
Mailing Address - Phone:650-733-6159
Mailing Address - Fax:
Practice Address - Street 1:161 S SPRUCE AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4517
Practice Address - Country:US
Practice Address - Phone:650-871-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95056318OtherBOARD OF REGISTERED NURSING
CANP95009069OtherBOARD OF REGISTERED NURSING