Healthcare Provider Details

I. General information

NPI: 1063916567
Provider Name (Legal Business Name): STANLEY HERMAN CHENG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 J ST STE C
SACRAMENTO CA
95819-3957
US

IV. Provider business mailing address

5609 J ST STE C
SACRAMENTO CA
95819-3957
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-8696
  • Fax: 916-453-8715
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number20A21642
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A21642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: