Provider Demographics
NPI:1174557235
Name:NG, KEVIN KOK-FOO (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KOK-FOO
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:KOK-FOO NG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13911 OLD SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3630
Mailing Address - Country:US
Mailing Address - Phone:954-680-8505
Mailing Address - Fax:954-680-8303
Practice Address - Street 1:13911 OLD SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33330-3630
Practice Address - Country:US
Practice Address - Phone:954-680-8505
Practice Address - Fax:954-680-8303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067662400Medicaid
FL41710OtherME #
FL067662400Medicaid
D27963Medicare UPIN
FL96233CMedicare PIN