1750661807 NPI number — KENG-SIANG PNG MBBS

Table of content: KENG-SIANG PNG MBBS (NPI 1750661807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750661807 NPI number — KENG-SIANG PNG MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PNG
Provider First Name:
KENG-SIANG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750661807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 BARNHILL DR
Provider Second Line Business Mailing Address:
STE 420
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-5116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-274-7451
Provider Business Mailing Address Fax Number:
317-274-0174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 BARNHILL DR
Provider Second Line Business Practice Location Address:
STE 420
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-274-7451
Provider Business Practice Location Address Fax Number:
317-274-0174
Provider Enumeration Date:
08/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  11015911A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11015911A . This is a "INDIANA LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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