Provider Demographics
NPI:1982356283
Name:TINGSUK, PON (PPS)
Entity Type:Individual
Prefix:MISS
First Name:PON
Middle Name:
Last Name:TINGSUK
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0942
Mailing Address - Country:US
Mailing Address - Phone:626-215-6962
Mailing Address - Fax:
Practice Address - Street 1:365 SIERRA PARK RD RM 103
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-6129
Practice Address - Country:US
Practice Address - Phone:760-924-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180065956101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool