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General NPI Number Information
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NPI Number | 1528851383
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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 |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHRISTOPHER CHENG
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Credential | MD, PHD
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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 | 2084D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Psychiatry & Neurology) 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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health 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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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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 | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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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 | 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 #7
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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