Healthcare Provider Details

I. General information

NPI: 1104046853
Provider Name (Legal Business Name): SANTA ANA PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE SUITE 155
FOUNTAIN VALLEY CA
92708-7501
US

IV. Provider business mailing address

11180 WARNER AVE SUITE 155
FOUNTAIN VALLEY CA
92708-7501
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-1688
  • Fax: 714-641-2919
Mailing address:
  • Phone: 714-546-1688
  • Fax: 714-641-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE-3380
License Number StateCA

VIII. Authorized Official

Name: DR. BENEDICT CHING
Title or Position: OWNER
Credential: DPM
Phone: 714-546-1688