Basic Information
| Provider Information | |||||||||
| NPI: | 1154386415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NG | ||||||||
| FirstName: | GORDON | ||||||||
| MiddleName: | W.T. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 N KUAKINI ST | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085220190 | ||||||||
| FaxNumber: | 8085239068 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 N KUAKINI ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968172306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085220190 | ||||||||
| FaxNumber: | 8085239068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD7714 | HI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0000095448 | 01 | HI | QUEST HMSA | OTHER | B095444 | 01 | HI | HMSA | OTHER | 0095448 | 01 | HI | HMSA | OTHER | 07343502 | 01 | HI | QUEST ALOHACARE | OTHER | 00B0095444 | 01 | HI | QUEST HMSA | OTHER | 103802483 | 01 | HI | US MARSHALL SVC-FED DET C | OTHER | 201243800 | 01 | HI | US LABOR DEPT | OTHER | 300044845 | 01 | HI | PALMETTO GBA | OTHER | 073435-02 | 01 | HI | ST DEPT OF PUB SAFETY | OTHER | 108-2145098 | 01 | HI | AETNA | OTHER | 990157698-96701-B005 | 01 | HI | TRICARE | OTHER | 0007343502 | 05 | HI | MEDICAID | 0007343503 | 05 | HI | MEDICAID | 990157698006 | 01 | HI | HI ELEC | OTHER | MD7714 | 01 | HI | QUEENS HEALTHCARE | OTHER | 990157698-96817-E005 | 01 | HI | TRICARE | OTHER |