Healthcare Provider Details

I. General information

NPI: 1609216860
Provider Name (Legal Business Name): JENNIFER CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S
SEATTLE WA
98104-3032
US

IV. Provider business mailing address

720 8TH AVE S
SEATTLE WA
98104-3032
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3700
  • Fax: 206-652-5216
Mailing address:
  • Phone: 206-788-3700
  • Fax: 206-652-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number61251875
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61251875
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: