Healthcare Provider Details

I. General information

NPI: 1780476739
Provider Name (Legal Business Name): ANDY CHENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2025
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3298
US

IV. Provider business mailing address

535 HARRISON RD
MONTEREY PARK CA
91755-6730
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone: 903-245-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95221405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: