Healthcare Provider Details

I. General information

NPI: 1588245351
Provider Name (Legal Business Name): CHIA PO CHENG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST STE 204B
STUDIO CITY CA
91604-2158
US

IV. Provider business mailing address

11712 MOORPARK ST STE 204B
STUDIO CITY CA
91604-2158
US

V. Phone/Fax

Practice location:
  • Phone: 424-258-0609
  • Fax:
Mailing address:
  • Phone: 424-258-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94028561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC010692
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: