Provider Demographics
NPI:1295842128
Name:CHENG, MARLYN LEE (MD)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:LEE
Last Name:CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 S ROBERTSON BLVD # 175
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1403
Mailing Address - Country:US
Mailing Address - Phone:310-625-4944
Mailing Address - Fax:310-559-9507
Practice Address - Street 1:1171 S ROBERTSON BLVD # 175
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1403
Practice Address - Country:US
Practice Address - Phone:310-625-4944
Practice Address - Fax:310-559-9507
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52302207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00448019OtherRAILROAD MEDICARE
CA00A523021Medicaid
CAP00448019OtherRAILROAD MEDICARE
CA00A523021Medicaid