Healthcare Provider Details

I. General information

NPI: 1982786521
Provider Name (Legal Business Name): JUDY CHENG-CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 E EDINGER AVE
SANTA ANA CA
92705-5001
US

IV. Provider business mailing address

PO BOX 19333
IRVINE CA
92623-9333
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-8904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG71136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: