Healthcare Provider Details

I. General information

NPI: 1528240926
Provider Name (Legal Business Name): VICTOR LEON CHEANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

IV. Provider business mailing address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

V. Phone/Fax

Practice location:
  • Phone: 323-545-8090
  • Fax: 323-344-8829
Mailing address:
  • Phone: 323-545-8090
  • Fax: 323-344-8829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA101655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: