=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649764879
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY CHENG OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2018
-----------------------------------------------------
Last Update Date | 12/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4867 W SUNSET BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-5969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-574-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2307 S HALM AVE APT 1
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90034-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-919-7647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 4381AT
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------