Healthcare Provider Details

I. General information

NPI: 1942593082
Provider Name (Legal Business Name): NICOLE LING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 10/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94158-2350
US

IV. Provider business mailing address

550 16TH ST 5TH FLOOR, BOX 0632
SAN FRANCISCO CA
94158-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number116547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: