Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 22790 | SC |
NPI | 1013096759 |
---|---|
Provider Name | Dr. Richard Zhang Cheng |
First Address | Columbia, SC 29212-3149 |
Second Address | Columbia, SC 29212-3149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 24/10/2011 |