Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 002997 | GA |
N | 111NI0900X | Internist | 002997 | GA |
Y | 207RA0201X | Internist - Allergy & Immunology | A115643 | CA |
NPI | 1609038355 |
---|---|
Provider Name | Gang Cheng |
First Address | Modesto, CA 95355-4201 |
Second Address | Modesto, CA 95355-4201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 17/03/2018 |