Healthcare Provider Details

I. General information

NPI: 1821490970
Provider Name (Legal Business Name): BENEDICT YH CHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST SUITE 3400
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

18111 BROOKHURST ST SUITE3400
FOUNTAIN VALLEY CA
92708-6728
US

V. Phone/Fax

Practice location:
  • Phone: 714-861-4637
  • Fax: 714-861-4631
Mailing address:
  • Phone: 714-861-4631
  • Fax: 714-861-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE3380
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberE3380
License Number StateCA

VIII. Authorized Official

Name: BENEDICT YH CHING
Title or Position: OWNER
Credential: DPM
Phone: 714-861-4631