Provider Demographics
NPI:1871523639
Name:TING, GRACE (DPM)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:TING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3500
Mailing Address - Country:US
Mailing Address - Phone:626-289-4379
Mailing Address - Fax:626-289-4791
Practice Address - Street 1:27 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3500
Practice Address - Country:US
Practice Address - Phone:626-289-4379
Practice Address - Fax:626-289-4791
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3606213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36060Medicaid
CAZZZ08615ZOtherBLUE SHIELD
CA000E36060Medicaid
CAP00207881Medicare PIN
CAWE3606DMedicare PIN