Basic Information
Provider Information
NPI: 1003291428
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NG
FirstName: ERNEST
MiddleName: CHI KONG
NamePrefix:  
NameSuffix:  
Credential: P.A.-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 E PRINCETON ST STE 310
Address2:  
City: ORLANDO
State: FL
PostalCode: 328031468
CountryCode: US
TelephoneNumber: 4073035781
FaxNumber: 4073035794
Practice Location
Address1: 615 E PRINCETON ST STE 310
Address2:  
City: ORLANDO
State: FL
PostalCode: 328031468
CountryCode: US
TelephoneNumber: 4073035781
FaxNumber: 4073035794
Other Information
ProviderEnumerationDate: 07/27/2015
LastUpdateDate: 10/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA9109498FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X NYN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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