Provider Demographics
NPI:1477631257
Name:ING, DENNIS K (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:K
Last Name:ING
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 1:835 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4219
Mailing Address - Country:US
Mailing Address - Phone:510-908-2513
Mailing Address - Fax:510-881-4688
Practice Address - Street 1:835 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4219
Practice Address - Country:US
Practice Address - Phone:510-908-2513
Practice Address - Fax:510-881-4688
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G478780Medicaid
F16572Medicare UPIN
CA00G478780Medicaid