Provider Demographics
NPI:1396912770
Name:NG, ANGIE (LAC)
Entity type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:223 W JACKSON BLVD STE 860
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6916
Mailing Address - Country:US
Mailing Address - Phone:312-890-5553
Mailing Address - Fax:312-312-9605
Practice Address - Street 1:223 W JACKSON BLVD STE 860
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6916
Practice Address - Country:US
Practice Address - Phone:312-890-5553
Practice Address - Fax:312-312-9605
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000772171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist