Provider Demographics
NPI:1174019368
Name:VDEX MEDICAL GROUP - CHENG
Entity Type:Organization
Organization Name:VDEX MEDICAL GROUP - CHENG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIZUHARA-CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-661-6367
Mailing Address - Street 1:21201 VICTORY BLVD STE 265
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4059
Mailing Address - Country:US
Mailing Address - Phone:818-661-6367
Mailing Address - Fax:818-661-6367
Practice Address - Street 1:21201 VICTORY BLVD STE 265
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4059
Practice Address - Country:US
Practice Address - Phone:818-661-6367
Practice Address - Fax:818-661-6367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty