Provider Demographics
NPI:1730247057
Name:DAVID C. NG, DPM, INC.
Entity type:Organization
Organization Name:DAVID C. NG, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHANG
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:805-497-7822
Mailing Address - Street 1:13960 BLACK ROCK CIR
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-5025
Mailing Address - Country:US
Mailing Address - Phone:805-497-7822
Mailing Address - Fax:805-293-6768
Practice Address - Street 1:123 HODENCAMP RD STE 101
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5833
Practice Address - Country:US
Practice Address - Phone:805-497-7822
Practice Address - Fax:805-293-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41110Medicaid
CA000E41111OtherBLUE SHIELD PROVIDER ID #
CA5429910002Medicare NSC
CAW18943AMedicare ID - Type UnspecifiedPROVIDER ID NUMBER (PIN)
GADE8308Medicare ID - Type UnspecifiedRAILROAD GROUP NUMBER