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General NPI Number Information
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NPI Number | 1134352289
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Entity Type | Organization
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Legal Business Name | KELLVAN J CHENG, DPM, PA
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 4222 TRINITY MILLS ROAD 112
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City | DALLAS
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State | TX
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Zip | 75287-7603
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Country | US
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Telephone | 214-710-1028
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Fax | 214-710-1029
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Provider Business Mailing Address
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Address Line | 4222 TRINITY MILLS ROAD 112
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City | DALLAS
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State | TX
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Zip | 75287-7603
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Country | US
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Telephone | 214-710-1028
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Fax | 214-710-1029
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Authorized Official
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Title or Position | FOOT & ANKLE SURGEON / PRESIDENT
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Name | DR. KELLVAN J CHENG
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Credential | DPM
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Telephone | 214-710-1028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1763
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License Number State | TX
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