Healthcare Provider Details

I. General information

NPI: 1225110968
Provider Name (Legal Business Name): JULIE C CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15975 HARBOR BLVD
FOUNTAIN VALLEY CA
92708-1303
US

IV. Provider business mailing address

2 OAKDALE
IRVINE CA
92604-3221
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-6575
  • Fax: 714-551-9411
Mailing address:
  • Phone: 714-546-6575
  • Fax: 714-551-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA79108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: