MEDICARE: GORDON CHIH-JEN CHENG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A127844	CA

General Provider Information

NPI Number	:	1740540558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON CHIH-JEN CHENG M.D.

Provider Business Mailing Address
First Line	:	12036 SCRIPPS HIGHLANDS DR
Second Line	:	STE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-5155
Country	:	US
Telephone Number	:	858-566-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	12036 SCRIPPS HIGHLANDS DR
Second Line	:	STE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-5155
Country	:	US
Telephone Number	:	858-566-4444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2012
Last Update Date	:	07/08/2015

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