Provider Demographics
NPI:1902851504
Name:NG, CHERESA C (MD)
Entity Type:Individual
Prefix:
First Name:CHERESA
Middle Name:C
Last Name:NG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HAYES ST STE 408
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1078
Mailing Address - Country:US
Mailing Address - Phone:415-221-6668
Mailing Address - Fax:415-221-2942
Practice Address - Street 1:2250 HAYES ST STE 408
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1078
Practice Address - Country:US
Practice Address - Phone:415-221-6668
Practice Address - Fax:415-221-2942
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81035207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG810350Medicaid
G87121Medicare UPIN
CAOOG810350Medicaid