Provider Demographics
NPI:1942200548
Name:NG, STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:5575 W LAS POSITAS BLVD
Mailing Address - Street 2:#130
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5801
Mailing Address - Country:US
Mailing Address - Phone:925-463-0590
Mailing Address - Fax:925-847-9532
Practice Address - Street 1:5575 W LAS POSITAS BLVD
Practice Address - Street 2:#130
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5801
Practice Address - Country:US
Practice Address - Phone:925-463-0590
Practice Address - Fax:925-847-9532
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA76047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A760470Medicaid
CA00A760470Medicaid
CA00A760470Medicare ID - Type Unspecified