Provider Demographics
NPI:1871600114
Name:ING, JEFFREY JOHN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:ING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:388 YPAO RD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3701
Mailing Address - Country:US
Mailing Address - Phone:671-646-8881
Mailing Address - Fax:671-646-1292
Practice Address - Street 1:1617 SAINT MARKS PLZ
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6423
Practice Address - Country:US
Practice Address - Phone:209-478-1797
Practice Address - Fax:209-478-1224
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GUM-2308207W00000X
CAG78322207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G783220Medicaid
CA00G783220Medicaid
CAG35647Medicare UPIN