Healthcare Provider Details

I. General information

NPI: 1780685388
Provider Name (Legal Business Name): EMILIA CHUA TING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

1095 E SHAW AVE SUITE 203
FRESNO CA
93710-7813
US

IV. Provider business mailing address

1095 E SHAW AVE SUITE 203
FRESNO CA
93710-7813
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-7251
  • Fax: 559-221-7614
Mailing address:
  • Phone: 559-221-7251
  • Fax: 559-221-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA31181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: