Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | IL | |
N | 207QA0401X | Family Doctor - Addiction Medicine | IL |
NPI | 1346202140 |
---|---|
Provider Name | Richard H Ng |
First Address | Dekalb, IL 60115 |
Second Address | Dekalb, IL 60115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D14848 | (02) |