Provider Demographics
NPI:1366934689
Name:NG, NATHAN (MSTCM, DACM, LAC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:MSTCM, DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2606
Mailing Address - Country:US
Mailing Address - Phone:415-813-7688
Mailing Address - Fax:
Practice Address - Street 1:1700 SHATTUCK AVE STE 2
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-3401
Practice Address - Country:US
Practice Address - Phone:415-813-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist