Healthcare Provider Details

I. General information

NPI: 1124601133
Provider Name (Legal Business Name): LI-WEN CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 GEARY BLVD
SAN FRANCISCO CA
94118-3003
US

IV. Provider business mailing address

2250 45TH AVE
SAN FRANCISCO CA
94116-1503
US

V. Phone/Fax

Practice location:
  • Phone: 310-494-1637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: