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General NPI Number Information
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NPI Number | 1417018342
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Entity Type | Individual
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Provider Name | MARC BUNJIUN CHENG M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 13768 ROSWELL AVE STE 218
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City | CHINO
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State | CA
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Zip | 91710-1407
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Country | US
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Telephone | 909-732-9781
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Fax |
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Provider Business Mailing Address
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Address Line | 382 N LEMON AVE # 180
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City | WALNUT
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State | CA
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Zip | 91789-2344
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Country | US
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Telephone | 909-816-4428
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A85749
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A85749
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A85749
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License Number State | CA
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