Healthcare Provider Details

I. General information

NPI: 1740484633
Provider Name (Legal Business Name): PERSONALCARE PHYSICIANS OF NEWPORT BEACH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E COAST HWY STE 250
CORONA DEL MAR CA
92625-1932
US

IV. Provider business mailing address

2121 E COAST HWY STE 250
CORONA DEL MAR CA
92625-1932
US

V. Phone/Fax

Practice location:
  • Phone: 949-706-3300
  • Fax: 949-706-3301
Mailing address:
  • Phone: 949-706-3300
  • Fax: 949-706-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH S. CHENG
Title or Position: PHYSICIAN
Credential:
Phone: 949-706-3300