Healthcare Provider Details

I. General information

NPI: 1548554629
Provider Name (Legal Business Name): CHENGTAI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27001 LA PAZ RD SUITE290
MISSION VIEJO CA
92691-5502
US

IV. Provider business mailing address

27001 LA PAZ RD SUITE290
MISSION VIEJO CA
92691-5502
US

V. Phone/Fax

Practice location:
  • Phone: 949-770-4327
  • Fax:
Mailing address:
  • Phone: 949-770-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberHA7263
License Number StateCA

VIII. Authorized Official

Name: MR. FENG QUAN
Title or Position: PRESIDENT
Credential: AUDIOPROSTHOLOGIST
Phone: 949-770-4327