Provider Demographics
NPI:1669495214
Name:CHING, ANDREA SHERYL JANELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SHERYL JANELLE
Last Name:CHING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 N 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4904
Mailing Address - Country:US
Mailing Address - Phone:909-982-8846
Mailing Address - Fax:909-949-3967
Practice Address - Street 1:555 N 13TH AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4904
Practice Address - Country:US
Practice Address - Phone:909-982-8846
Practice Address - Fax:909-949-3967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70709207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A707090Medicaid
CA00A707090Medicare PIN
CAH68304Medicare UPIN
CA00A707090Medicaid