Provider Demographics
NPI:1912045113
Name:TING, PEGGY K
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:K
Last Name:TING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15214 OAKENCROFT DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-4743
Mailing Address - Country:US
Mailing Address - Phone:661-397-7400
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:4401 MING AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4817
Practice Address - Country:US
Practice Address - Phone:661-397-7400
Practice Address - Fax:661-397-5639
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD48040Medicaid