Provider Demographics
NPI:1154373066
Name:CHENG, ANGELA C (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 HUNTINGTON DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4552
Mailing Address - Country:US
Mailing Address - Phone:626-823-0450
Mailing Address - Fax:626-403-6440
Practice Address - Street 1:1499 HUNTINGTON DR
Practice Address - Street 2:SUITE 318
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4552
Practice Address - Country:US
Practice Address - Phone:626-823-0450
Practice Address - Fax:626-403-6440
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA787732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI35205Medicare UPIN