Provider Demographics
NPI:1841633393
Name:NG, MAGNOLIA (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:MAGNOLIA
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16040 LEFFINGWELL RD
Mailing Address - Street 2:#90
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-3158
Mailing Address - Country:US
Mailing Address - Phone:415-505-6886
Mailing Address - Fax:
Practice Address - Street 1:17291 IRVINE BLVD
Practice Address - Street 2:STE 103
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2941
Practice Address - Country:US
Practice Address - Phone:415-505-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32598111N00000X
CAAC15326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist