Provider Demographics
NPI:1275299281
Name:CHENG, WAN YING JENNY (PHARMD)
Entity Type:Individual
Prefix:
First Name:WAN YING
Middle Name:JENNY
Last Name:CHENG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30192 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2037
Mailing Address - Country:US
Mailing Address - Phone:949-495-8414
Mailing Address - Fax:
Practice Address - Street 1:30192 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2037
Practice Address - Country:US
Practice Address - Phone:949-495-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist