Provider Demographics
NPI:1851527576
Name:NG, SERAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SERAN
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 GALE AVE
Mailing Address - Street 2:298
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1601
Mailing Address - Country:US
Mailing Address - Phone:626-855-4320
Mailing Address - Fax:
Practice Address - Street 1:126 GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-4712
Practice Address - Country:US
Practice Address - Phone:626-855-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594341223P0221X
NV61411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry