Provider Demographics
NPI:1134940372
Name:CHING, CARL MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:MICHAEL
Last Name:CHING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:CARL MICHAEL
Other - Middle Name:SY
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1481 LEA LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7150
Mailing Address - Country:US
Mailing Address - Phone:559-375-5889
Mailing Address - Fax:
Practice Address - Street 1:6121 HOLLIS ST STE 400
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2077
Practice Address - Country:US
Practice Address - Phone:510-645-9900
Practice Address - Fax:510-806-3056
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95125845163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator