Provider Demographics
NPI:1306866033
Name:TING, SHIRLEY FONG (M B)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:FONG
Last Name:TING
Suffix:
Gender:F
Credentials:M B
Other - Prefix:DR
Other - First Name:FONG
Other - Middle Name:
Other - Last Name:TING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB
Mailing Address - Street 1:1565 VINEYARD DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-7261
Mailing Address - Country:US
Mailing Address - Phone:650-691-9608
Mailing Address - Fax:650-691-9608
Practice Address - Street 1:10050 IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5905
Practice Address - Country:US
Practice Address - Phone:408-865-0936
Practice Address - Fax:408-865-0976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43758208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics