Healthcare Provider Details

I. General information

NPI: 1457805855
Provider Name (Legal Business Name): YI-CHUN CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 SAN GABRIEL BLVD
ROSEMEAD CA
91770-2536
US

IV. Provider business mailing address

121 AUTUMN OAKS LN
GLENDORA CA
91741-6613
US

V. Phone/Fax

Practice location:
  • Phone: 626-773-8900
  • Fax:
Mailing address:
  • Phone: 626-731-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: