Provider Demographics
NPI:1073619706
Name:CHENG, PAUL P (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:P
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PU-JIN
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:433 ESTUDILLO AVENUE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4915
Mailing Address - Country:US
Mailing Address - Phone:510-352-8585
Mailing Address - Fax:510-352-8644
Practice Address - Street 1:433 ESTUDILLO AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:510-352-8585
Practice Address - Fax:510-352-8644
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046213207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61729Medicare UPIN