=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003161795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIC ENDOCRINOLOGY & DIABETES CONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2012
-----------------------------------------------------
Last Update Date | 07/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9900 STOCKDALE HWY SUITE 105
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-836-7799
-----------------------------------------------------
Fax | 661-840-5934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9900 STOCKDALE HWY SUITE 105
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93311-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-836-7799
-----------------------------------------------------
Fax | 661-840-5934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN CHING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 661-836-7799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | A92055
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------