=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629462106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERNEST CHENG, D.O., PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2015
-----------------------------------------------------
Last Update Date | 03/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5720 STONERIDGE MALL RD STE. 250
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-237-9808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5087 SALERNO DR
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94568-7358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-999-9581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ERNEST CHENG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 925-999-9581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 20A9544
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 20A9544
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 20A9544
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------