Provider Demographics
NPI:1669540464
Name:NG, CHI-KIN (MD)
Entity type:Individual
Prefix:
First Name:CHI-KIN
Middle Name:
Last Name:NG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6111 OLIVET DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3877
Mailing Address - Country:US
Mailing Address - Phone:352-207-6354
Mailing Address - Fax:734-201-1969
Practice Address - Street 1:6111 OLIVET DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3877
Practice Address - Country:US
Practice Address - Phone:352-207-6354
Practice Address - Fax:734-201-1969
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012359142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VAC09633OtherMEDICARE GROUP PTAN
VA010371058Medicaid
VAP00421903Medicare PIN
VAC10730Medicare PIN
VA010371058Medicaid
VAC09633OtherMEDICARE GROUP PTAN
VAD54789Medicare UPIN