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General NPI Number Information
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NPI Number | 1447472691
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Entity Type | Organization
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Legal Business Name | IRENE M. TING D.M.D A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 885 CANARIOS COURT #212
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City | CHULA VISTA
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State | CA
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Zip | 91910
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Country | US
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Telephone | 619-397-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 668 EL PORTAL DRIVE
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City | CHULA VISTA
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State | CA
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Zip | 91914
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Country | US
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Telephone | 619-216-1783
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. IRENE MALABANAN TING
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Credential | D.M.D
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Telephone | 619-397-7162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45034
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License Number State | CA
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