Provider Demographics
NPI:1366463499
Name:YU CHENG JEFFREY CHEN MD LLC A PROFESSIONAL MEDICAL COMPANY
Entity Type:Organization
Organization Name:YU CHENG JEFFREY CHEN MD LLC A PROFESSIONAL MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YU CHENG
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-981-8131
Mailing Address - Street 1:4212 W CONGRESS ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6765
Mailing Address - Country:US
Mailing Address - Phone:337-981-8131
Mailing Address - Fax:337-989-1316
Practice Address - Street 1:4212 W CONGRESS ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6765
Practice Address - Country:US
Practice Address - Phone:337-981-8131
Practice Address - Fax:337-989-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1449008Medicaid
LA5CV19Medicare PIN