=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780129494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHENG MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2017
-----------------------------------------------------
Last Update Date | 01/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12945 SARATOGA AVE
-----------------------------------------------------
City | SARATOGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95070-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-255-3223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12945 SARATOGA AVE
-----------------------------------------------------
City | SARATOGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95070-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-255-3223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER/PRESIDENT
-----------------------------------------------------
Name | DR. ELBERT T CHENG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 408-255-3223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0007X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------