Healthcare Provider Details

I. General information

NPI: 1548648041
Provider Name (Legal Business Name): AMY CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CARL KARCHER WAY
ANAHEIM CA
92801
US

IV. Provider business mailing address

5938 BIXBY VILLAGE DR APT 203
LONG BEACH CA
90803-6329
US

V. Phone/Fax

Practice location:
  • Phone: 657-282-6356
  • Fax:
Mailing address:
  • Phone: 703-473-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA147350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: