Provider Demographics
NPI:1982356283
Name:TINGSUK, PON (PPS)
Entity type:Individual
Prefix:MS
First Name:PON
Middle Name:
Last Name:TINGSUK
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-0130
Mailing Address - Country:US
Mailing Address - Phone:760-934-0031
Mailing Address - Fax:
Practice Address - Street 1:625 OLD MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-6359
Practice Address - Country:US
Practice Address - Phone:760-924-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180065956101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool