Basic Information
| Provider Information | |||||||||
| NPI: | 1336239946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NG | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | PAK-NIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11750 W 2ND PL | ||||||||
| Address2: | SUITE 255 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203218040 | ||||||||
| FaxNumber: | 7203218041 | ||||||||
| Practice Location | |||||||||
| Address1: | 11750 W 2ND PL | ||||||||
| Address2: | SUITE 255 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802281575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7203218040 | ||||||||
| FaxNumber: | 7203218041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 10/06/2017 | ||||||||
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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 | 2085N0700X | DR.0053442 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 5995797-1205 | UT | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 53442 | CO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 25455851 | 05 | CO | MEDICAID |