Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 104556 | CA |
NPI | 1003307976 |
---|---|
Provider Name | Irene L Ching |
First Address | Los Angeles, CA 90089-0058 |
Second Address | Los Angeles, CA 90089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 30/06/2020 |