Provider Demographics
NPI:1265458301
Name:CHENG, ROGER TSUNG-YUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:TSUNG-YUN
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 JACKSON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3901
Mailing Address - Country:US
Mailing Address - Phone:951-354-2500
Mailing Address - Fax:951-687-8150
Practice Address - Street 1:3975 JACKSON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3901
Practice Address - Country:US
Practice Address - Phone:951-354-2500
Practice Address - Fax:951-687-8150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A39382-0Medicare ID - Type Unspecified
A28880Medicare UPIN
00A39382-1Medicare ID - Type Unspecified