Provider Demographics
NPI:1356539761
Name:NG, WAYNE (CMT)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2820
Mailing Address - Country:US
Mailing Address - Phone:415-221-0371
Mailing Address - Fax:
Practice Address - Street 1:683 29TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2820
Practice Address - Country:US
Practice Address - Phone:415-221-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171W00000X
305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No305S00000XManaged Care OrganizationsPoint of Service