Provider Demographics
NPI:1750462487
Name:JOSE A DHEMING MD INC
Entity Type:Organization
Organization Name:JOSE A DHEMING MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DHEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-902-9934
Mailing Address - Street 1:5385 WALNUT AVE
Mailing Address - Street 2:# 4
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2605
Mailing Address - Country:US
Mailing Address - Phone:909-902-9934
Mailing Address - Fax:909-902-0754
Practice Address - Street 1:5385 WALNUT AVE
Practice Address - Street 2:# 4
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2605
Practice Address - Country:US
Practice Address - Phone:909-902-9934
Practice Address - Fax:909-902-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556110Medicaid
CA00A556110Medicaid
CAZZZ01809ZMedicare PIN