Healthcare Provider Details

I. General information

NPI: 1790578557
Provider Name (Legal Business Name): CCM SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 116TH AVE NE STE 200B
BELLEVUE WA
98004-3097
US

IV. Provider business mailing address

710 S 348TH ST STE B
FEDERAL WAY WA
98003-7042
US

V. Phone/Fax

Practice location:
  • Phone: 425-276-1825
  • Fax: 855-785-8770
Mailing address:
  • Phone: 425-276-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2080P1004X
TaxonomyPhysician Nutrition Specialist (Pediatrics)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER CHENG
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 425-276-1825