Provider Demographics
NPI:1700074549
Name:NG, KONRAD (MD)
Entity Type:Individual
Prefix:
First Name:KONRAD
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST STE 314
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2377
Mailing Address - Country:US
Mailing Address - Phone:415-737-0555
Mailing Address - Fax:415-737-0595
Practice Address - Street 1:2100 WEBSTER ST STE 314
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2377
Practice Address - Country:US
Practice Address - Phone:415-737-0555
Practice Address - Fax:415-737-0595
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA99746208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA154006Medicare PIN