| Entity Name: | CHI-KWONG NG, M.D. P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Mar 1996 (29 years ago) |
| Document Number: | P96000028434 |
| FEI/EIN Number | 593401731 |
| Address: | 905 N CITRUS AVENUE, CRYSTAL RIVER, FL, 34428, US |
| Mail Address: | 905 N CITRUS AVENUE, CRYSTAL RIVER, FL, 34428, US |
| ZIP code: | 34428 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457652968 | 2010-11-15 | 2010-12-08 | 905 N CITRUS AVE, CRYSTAL RIVER, FL, 344283422, US | 905 N CITRUS AVE, CRYSTAL RIVER, FL, 344283422, US | |||||||||||||||||||||||||
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| Phone | +1 352-563-5767 |
| Fax | 3525635705 |
Authorized person
| Name | DR. CHI-KWONG NG |
| Role | PRESIDENT |
| Phone | 3525635767 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME0068881 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 379840200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SERRA EDWARD J | Agent | 6118 W CORPORATE OAKS DRIVE, CRYSTAL RIVER, FL, 34429 |
| Name | Role | Address |
|---|---|---|
| NG CHI-KWONG M | Treasurer | 905 N CITRUS AVE, CRYSTAL RIVER, FL, 34428 |
| Name | Role | Address |
|---|---|---|
| NG CHI-KWONG M | Director | 905 N CITRUS AVE, CRYSTAL RIVER, FL, 34428 |
| Name | Role | Address |
|---|---|---|
| NG CHI-KWONG M | President | 905 N CITRUS AVE, CRYSTAL RIVER, FL, 34428 |
| Name | Role | Address |
|---|---|---|
| NG LEE-SHIN | Vice President | 905 N CITRUS AVE, CRYSTAL RIVER, FL, 34428 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
