Healthcare Provider Details

I. General information

NPI: 1215315940
Provider Name (Legal Business Name): BRIAN CHUN FANG CHENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE STE 201
DOWNEY CA
90241-5022
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE STE 201
DOWNEY CA
90241-5022
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-4480
  • Fax:
Mailing address:
  • Phone: 562-904-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA146619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: