Provider Demographics
NPI:1972044246
Name:NG, ADRIAN JUN YEN
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:JUN YEN
Last Name:NG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N TUSTIN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3850
Mailing Address - Country:US
Mailing Address - Phone:714-619-5383
Mailing Address - Fax:714-619-5396
Practice Address - Street 1:400 N TUSTIN AVE STE 400
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3850
Practice Address - Country:US
Practice Address - Phone:714-619-5383
Practice Address - Fax:714-619-5396
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA157053207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program