Provider Demographics
NPI:1992448815
Name:NG, MICHAEL JONATHAN (DACM, MS, LAC, CES)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:NG
Suffix:
Gender:M
Credentials:DACM, MS, LAC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 TARAVAL ST # 309
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2422
Mailing Address - Country:US
Mailing Address - Phone:415-250-3390
Mailing Address - Fax:
Practice Address - Street 1:2355 OCEAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2622
Practice Address - Country:US
Practice Address - Phone:415-250-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist