Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A79990 | CA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | A79990 | CA |
NPI | 1093741175 |
---|---|
Provider Name | Dr. Jerry C Cheng |
First Address | Arcadia, CA 91007-5163 |
Second Address | Los Angeles, CA 90027-6082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 03/12/2021 |