Healthcare Provider Details

I. General information

NPI: 1669915948
Provider Name (Legal Business Name): SOPHIA CHENG JR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date: 07/09/2018
Reactivation Date: 06/22/2021

III. Provider practice location address

1340 TULLY RD
SAN JOSE CA
95122-3055
US

IV. Provider business mailing address

7221 VIA VICO
SAN JOSE CA
95129
US

V. Phone/Fax

Practice location:
  • Phone: 408-271-3900
  • Fax:
Mailing address:
  • Phone: 408-401-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN209795
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: