Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC23636 | CA |
NPI | 1154315406 |
---|---|
Provider Name | Mr. Patrick C Cheng |
First Address | South San Francisco, CA 94080-3532 |
Second Address | South San Francisco, CA 94080-3532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 19/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U69300 | (02) | CA |