Healthcare Provider Details

I. General information

NPI: 1396909362
Provider Name (Legal Business Name): JONATHAN CHENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MACARTHUR BLVD
OAKLAND CA
94611-5642
US

IV. Provider business mailing address

401 MONTE VISTA AVE APT 206
OAKLAND CA
94611-4583
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA103586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: