Provider Demographics
NPI:1053355198
Name:NG, ANGUS YATMAN (MD)
Entity type:Individual
Prefix:
First Name:ANGUS
Middle Name:YATMAN
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6095
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6095
Mailing Address - Country:US
Mailing Address - Phone:541-706-5922
Mailing Address - Fax:541-706-6869
Practice Address - Street 1:1253 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1334
Practice Address - Country:US
Practice Address - Phone:541-548-8131
Practice Address - Fax:541-526-6608
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092275A207P00000X
ORMD18320207P00000X
MN31939207P00000X
WAMD00026252207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2164NGOtherBSWA
WA8236341Medicaid
WA0171439OtherLIWA
WA0171438OtherLIWA
WANG5125OtherBSWA
WAG8236341Medicare PIN
WA2164NGOtherBSWA
WA0171438OtherLIWA
WA0171439OtherLIWA
WAG8852508Medicare PIN