Provider Demographics
NPI:1750325643
Name:DING, LARRY GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:GILBERT
Last Name:DING
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 1:218 AVENIDA LA CUESTA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2139
Mailing Address - Country:US
Mailing Address - Phone:949-444-1886
Mailing Address - Fax:888-873-6807
Practice Address - Street 1:6700 INDIANA AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4290
Practice Address - Country:US
Practice Address - Phone:951-248-9240
Practice Address - Fax:951-248-9263
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66008171100000X, 208100000X, 2081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No171100000XOther Service ProvidersAcupuncturist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G77154Medicare UPIN