Provider Demographics
NPI:1225709330
Name:CHENG, JUDY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11822 GOSHEN AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7328
Mailing Address - Country:US
Mailing Address - Phone:310-869-7504
Mailing Address - Fax:
Practice Address - Street 1:465 N ROXBURY DR STE 803
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4211
Practice Address - Country:US
Practice Address - Phone:310-274-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15478363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant