Provider Demographics
NPI:1215181722
Name:CHEN, CHENG-HAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHENG-HAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 BRISTOL STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7341
Mailing Address - Country:US
Mailing Address - Phone:714-445-0220
Mailing Address - Fax:714-445-0245
Practice Address - Street 1:24022 CALLE DE LA PLATA STE 500
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7612
Practice Address - Country:US
Practice Address - Phone:714-445-0220
Practice Address - Fax:714-445-0246
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110621207R00000X, 207RI0011X
NY278434207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA110621OtherCALIFORNIA MEDICAL LICENSE