Provider Demographics
NPI:1679552491
Name:NG, CHI-KWONG (MD)
Entity type:Individual
Prefix:DR
First Name:CHI-KWONG
Middle Name:
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 1:905 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-3422
Mailing Address - Country:US
Mailing Address - Phone:352-563-5767
Mailing Address - Fax:352-563-5705
Practice Address - Street 1:905 N CITRUS AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-3422
Practice Address - Country:US
Practice Address - Phone:352-563-5767
Practice Address - Fax:352-563-5705
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379840200Medicaid
FLG15126Medicare UPIN