Healthcare Provider Details

I. General information

NPI: 1801477484
Provider Name (Legal Business Name): EUNHAE PARK CHENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 140TH AVE NE BLDG C
BELLEVUE WA
98005-1892
US

IV. Provider business mailing address

2475 140TH AVE NE BLDG C
BELLEVUE WA
98005-1892
US

V. Phone/Fax

Practice location:
  • Phone: 425-828-2257
  • Fax: 425-896-7034
Mailing address:
  • Phone: 425-460-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.61557704
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: