Healthcare Provider Details

I. General information

NPI: 1336108695
Provider Name (Legal Business Name): TIEN H. CHENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 IOWA AVE STE 280
RIVERSIDE CA
92507-7401
US

IV. Provider business mailing address

1770 IOWA AVE STE 280
RIVERSIDE CA
92507-7401
US

V. Phone/Fax

Practice location:
  • Phone: 951-786-0801
  • Fax: 951-786-0460
Mailing address:
  • Phone: 951-786-0801
  • Fax: 951-786-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberG41600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG41600
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG41600
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME86768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: