PO-Ting CHI, DMD

Individual provider Active NPI General Practice Dentistry · Highland, CA

NPI 1770067639 · NPPES record last updated Sep 17, 2018

Key facts

NPI
1770067639
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
103130 (CA)
Practice address
7442 Tuolumne LN
Highland, CA 92346-7733
Phone
(909) 272-9905
NPI assigned
Sep 17, 2018
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20200911000926 CA Order and Referring Only - Dentist
Practitioner - Dentist
3577981232

National Provider Directory

Medicare enrollment (NPD)
Yes

Interoperability endpoints

  • Direct secure messaging: poting.chi.p1@direct.altura.nextgenshare.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223G0001X 103130 CA Yes

Addresses

Primary practice location

7442 Tuolumne LN
Highland, CA 92346-7733

Mailing address

7442 Tuolumne LN
Highland, CA 92346-7733

Other providers in Highland, CA

All providers in Highland, CA · General Practice Dentistry in California

Sources for this page

Verify at the official NPI Registry.