Healthcare Provider Details

I. General information

NPI: 1730752924
Provider Name (Legal Business Name): WEN-YU CHENG PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 401
PHOENIX AZ
85013-4423
US

IV. Provider business mailing address

222 W THOMAS RD STE 401
PHOENIX AZ
85013-4423
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY-005388
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005388
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: