Healthcare Provider Details

I. General information

NPI: 1497488241
Provider Name (Legal Business Name): HAIBO CHENG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 VANCE ST FL 2
CLINTON NC
28328-4001
US

IV. Provider business mailing address

501 WILLARD ST APT 118
DURHAM NC
27701-3280
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-9944
  • Fax: 910-763-4666
Mailing address:
  • Phone: 240-751-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12581
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: