Provider Demographics
NPI:1689677684
Name:DING LEI A PROFESSIONAL MEDICAL CORP
Entity Type:Organization
Organization Name:DING LEI A PROFESSIONAL MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEI
Authorized Official - Middle Name:
Authorized Official - Last Name:DING
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:626-581-4298
Mailing Address - Street 1:1661 HANOVER RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1796
Mailing Address - Country:US
Mailing Address - Phone:626-581-4298
Mailing Address - Fax:626-581-4398
Practice Address - Street 1:1661 HANOVER RD
Practice Address - Street 2:STE 101
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1796
Practice Address - Country:US
Practice Address - Phone:626-581-4298
Practice Address - Fax:626-581-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15929OtherPTAN
CAWA75815AMedicare UPIN