MEDICARE: OLIVER TING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689339806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER TING

Provider Business Mailing Address
First Line	:	831 NE 20TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-8209
Country	:	US
Telephone Number	:	405-626-3424
Fax Number	:

Provider Business Practice Location Address
First Line	:	831 NE 20TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-8209
Country	:	US
Telephone Number	:	405-626-3424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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Directions to “ OLIVER TING ” Practice Location

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