Provider Demographics
NPI:1083832927
Name:CHAO, STEPHEN CHENG-WEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHENG-WEN
Last Name:CHAO
Suffix:
Gender:M
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:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92856-6668
Mailing Address - Country:US
Mailing Address - Phone:714-639-8033
Mailing Address - Fax:
Practice Address - Street 1:8110 MANGO AVE STE 106
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3603
Practice Address - Country:US
Practice Address - Phone:909-266-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31842207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G318420Medicaid
CAG31842OtherCALIFORNIA STATE LICENSE
CA00G318420Medicaid