Healthcare Provider Details

I. General information

NPI: 1336672302
Provider Name (Legal Business Name): JESSICA CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA TSE

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FIVEPOINT
IRVINE CA
92618-2377
US

IV. Provider business mailing address

PO BOX 51285
LOS ANGELES CA
90051-5585
US

V. Phone/Fax

Practice location:
  • Phone: 949-671-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA157087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: