Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A69703 | CA |
NPI | 1043324544 |
---|---|
Provider Name | Dr. Ivan Cheng |
First Address | Redwood City, CA 94063-3132 |
Second Address | Redwood City, CA 94063-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 15/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H 87844 | (02) | CA |