1699713974 NPI number — DR. JUK L. TING D.O.

Table of content: DR. JUK L. TING D.O. (NPI 1699713974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699713974 NPI number — DR. JUK L. TING D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TING
Provider First Name:
JUK
Provider Middle Name:
L.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699713974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 N HOLLYWOOD WAY
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91505-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-557-0135
Provider Business Mailing Address Fax Number:
818-557-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15107 VANOWEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405-4542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-902-2990
Provider Business Practice Location Address Fax Number:
818-904-3793
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  20A7323 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20A7323 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00AX73230 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050359CG53273 . This is a "TULARE TRAILBLAZER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00AX73230 . This is a "CALOPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020A73230 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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