Healthcare Provider Details

I. General information

NPI: 1407475312
Provider Name (Legal Business Name): CHARLOTTE CHING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST STE 120
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

622 W 168TH ST RM 205
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4444
  • Fax:
Mailing address:
  • Phone: 212-305-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA186738
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: