Provider Demographics
NPI:1225184153
Name:JEAN CHENG, M.D. INC.
Entity Type:Organization
Organization Name:JEAN CHENG, M.D. INC.
Other - Org Name:THE SURGERY CENTER OF RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-785-5421
Mailing Address - Street 1:8990 GARFIELD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3922
Mailing Address - Country:US
Mailing Address - Phone:951-785-5421
Mailing Address - Fax:951-785-0130
Practice Address - Street 1:8990 GARFIELD ST STE 1
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3922
Practice Address - Country:US
Practice Address - Phone:951-785-5421
Practice Address - Fax:951-785-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000625261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical