Provider Demographics
NPI:1134500531
Name:SAN DIEGO VEIN INSTITUTE, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SAN DIEGO VEIN INSTITUTE, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRES
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-944-9263
Mailing Address - Street 1:336 ENCINITAS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-8707
Mailing Address - Country:US
Mailing Address - Phone:760-944-9263
Mailing Address - Fax:
Practice Address - Street 1:336 ENCINITAS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-8707
Practice Address - Country:US
Practice Address - Phone:760-944-9263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA861562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty