Healthcare Provider Details

I. General information

NPI: 1760316012
Provider Name (Legal Business Name): CHENG CHEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CORPORATE CENTER DR STE 100
MORROW GA
30260-4128
US

IV. Provider business mailing address

409 N 9TH CT
CORNELIUS OR
97113-9145
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-8888
  • Fax:
Mailing address:
  • Phone: 503-863-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: