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General NPI Number Information
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NPI Number | 1336932193
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Entity Type | Organization
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Legal Business Name | CCM SPECIALTY CARE LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 710 S 348TH ST STE B
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7042
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Country | US
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Telephone | 425-276-1825
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Fax |
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Provider Business Mailing Address
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Address Line | 710 S 348TH ST STE B
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7042
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Country | US
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Telephone | 425-276-1825
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Fax | 206-899-1299
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHRISOPHER CHENG
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Credential | MD
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Telephone | 425-276-1825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225B00000X
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Taxonomy Name | Pulmonary Function Technologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number |
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License Number State |
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