Provider Demographics
NPI:1245266576
Name:GRACE TING, DPM, INC.
Entity type:Organization
Organization Name:GRACE TING, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-289-4379
Mailing Address - Street 1:27 W MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3500
Mailing Address - Country:US
Mailing Address - Phone:626-289-4379
Mailing Address - Fax:626-289-4791
Practice Address - Street 1:27 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3500
Practice Address - Country:US
Practice Address - Phone:626-289-4379
Practice Address - Fax:626-289-4791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3606213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE001631Medicaid
CAZZZ08615ZOtherBLUE SHIELD PROVIDER ID
CAGRE001630Medicaid
CADD0918Medicare PIN
CAGRE001631Medicaid