Provider Demographics
NPI:1225187339
Name:CHRISTI CHENG MD INC
Entity type:Organization
Organization Name:CHRISTI CHENG MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-351-2100
Mailing Address - Street 1:13851 E 14TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2628
Mailing Address - Country:US
Mailing Address - Phone:510-351-2100
Mailing Address - Fax:510-357-3389
Practice Address - Street 1:13851 E 14TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2628
Practice Address - Country:US
Practice Address - Phone:510-351-2100
Practice Address - Fax:510-357-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G772110OtherCALIFORNIA LICENSE
CA00G772110OtherCALIFORNIA LICENSE