Provider Demographics
NPI:1245664515
Name:JONATHAN K. ENG, MD, INC.
Entity type:Organization
Organization Name:JONATHAN K. ENG, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-380-7750
Mailing Address - Street 1:713 W DUARTE RD
Mailing Address - Street 2:SUITE G-265
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7564
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 W DUARTE RD
Practice Address - Street 2:SUITE G-265
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7564
Practice Address - Country:US
Practice Address - Phone:626-281-5998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121799207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty