Healthcare Provider Details

I. General information

NPI: 1255684122
Provider Name (Legal Business Name): KENNETH S. CHING, MD., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 EAST NORTH STREET
MANTECA CA
95336
US

IV. Provider business mailing address

817 COFFEE ROAD C3
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-823-3111
  • Fax: 800-374-4232
Mailing address:
  • Phone: 209-529-9603
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG622561
License Number StateCA

VIII. Authorized Official

Name: KENNETH S CHING
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 209-529-9603