Provider Demographics
NPI:1396704896
Name:CHING, TIMOTHY NMI (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:NMI
Last Name:CHING
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 1:19804 GOLDEN BOUGH DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724
Mailing Address - Country:US
Mailing Address - Phone:626-331-8408
Mailing Address - Fax:
Practice Address - Street 1:19804 GOLDEN BOUGH DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724
Practice Address - Country:US
Practice Address - Phone:626-331-8408
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27819208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G278190Medicaid
CA00G278190Medicaid
CAG27819Medicare ID - Type Unspecified