Provider Demographics
NPI:1750661807
Name:PNG, KENG-SIANG (MBBS)
Entity Type:Individual
Prefix:
First Name:KENG-SIANG
Middle Name:
Last Name:PNG
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BARNHILL DR
Mailing Address - Street 2:STE 420
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5116
Mailing Address - Country:US
Mailing Address - Phone:317-274-7451
Mailing Address - Fax:317-274-0174
Practice Address - Street 1:535 BARNHILL DR
Practice Address - Street 2:STE 420
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5116
Practice Address - Country:US
Practice Address - Phone:317-274-7451
Practice Address - Fax:317-274-0174
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015911A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11015911AOtherINDIANA LICENSE