Provider Demographics
NPI:1134501521
Name:CHING, VIGNETTE (MTOM)
Entity Type:Individual
Prefix:
First Name:VIGNETTE
Middle Name:
Last Name:CHING
Suffix:
Gender:F
Credentials:MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 S LAKE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3593
Mailing Address - Country:US
Mailing Address - Phone:626-235-0591
Mailing Address - Fax:
Practice Address - Street 1:573 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3522
Practice Address - Country:US
Practice Address - Phone:626-235-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist