Provider Demographics
NPI:1114081528
Name:LING, JACK CHIK-PUI (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:CHIK-PUI
Last Name:LING
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 1:225 S LAKE AVE
Mailing Address - Street 2:#535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-396-0851
Practice Address - Street 1:309 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4308
Practice Address - Country:US
Practice Address - Phone:323-726-1222
Practice Address - Fax:323-725-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37386207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG37386AMedicare PIN
A91890Medicare UPIN