Healthcare Provider Details

I. General information

NPI: 1386064186
Provider Name (Legal Business Name): GRACE YU CHENG CHENG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GREENBOUGH
IRVINE CA
92614-5482
US

IV. Provider business mailing address

5 GREENBOUGH
IRVINE CA
92614-5482
US

V. Phone/Fax

Practice location:
  • Phone: 949-653-2789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number69860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: