Provider Demographics
NPI:1134510209
Name:MAO, CHENGCHENG
Entity Type:Individual
Prefix:
First Name:CHENGCHENG
Middle Name:
Last Name:MAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 E BERMUDA DUNES CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8715
Mailing Address - Country:US
Mailing Address - Phone:949-439-2508
Mailing Address - Fax:
Practice Address - Street 1:1788 SIERRA LEONE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-5886
Practice Address - Country:US
Practice Address - Phone:949-439-2508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist