Healthcare Provider Details

I. General information

NPI: 1043698061
Provider Name (Legal Business Name): JEREMIAH CHENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PIONEER LN
BISHOP CA
93514-2556
US

IV. Provider business mailing address

150 PIONEER LN
BISHOP CA
93514-2556
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-2623
  • Fax: 760-873-2626
Mailing address:
  • Phone: 760-873-5811
  • Fax: 760-872-5843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA143818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: