Healthcare Provider Details

I. General information

NPI: 1639637895
Provider Name (Legal Business Name): CHENG YI TENG YEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHENG YI TENG

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 04/09/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E LAMBERT RD STE 225
BREA CA
92821-4128
US

IV. Provider business mailing address

3723 CROOKED CREEK DR
DIAMOND BAR CA
91765-3761
US

V. Phone/Fax

Practice location:
  • Phone: 626-789-5796
  • Fax: 714-257-7987
Mailing address:
  • Phone: 347-604-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT109800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: