Provider Demographics
NPI:1710911011
Name:NG, JONATHAN TING (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TING
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1650
Mailing Address - Country:US
Mailing Address - Phone:408-295-0514
Mailing Address - Fax:408-295-9844
Practice Address - Street 1:1835 PARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1650
Practice Address - Country:US
Practice Address - Phone:408-295-0514
Practice Address - Fax:408-295-9844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41727207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48673Medicare UPIN
CA00G417270Medicare ID - Type Unspecified