Provider Demographics
NPI:1356427272
Name:LING, BENJAMIN (MD)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:LING
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 1:3105 CEDAR RAVINE ROAD
Mailing Address - Street 2:#101
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6561
Mailing Address - Country:US
Mailing Address - Phone:530-295-0600
Mailing Address - Fax:530-626-4337
Practice Address - Street 1:3105 CEDAR RAVINE ROAD
Practice Address - Street 2:#101
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6561
Practice Address - Country:US
Practice Address - Phone:530-295-0600
Practice Address - Fax:530-626-4337
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37385207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G373850Medicaid
CA00G373850Medicare ID - Type Unspecified
CA00G373850Medicaid