Provider Demographics
NPI:1437166949
Name:WANG-CHENG, REBEKAH MAY (MD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:MAY
Last Name:WANG-CHENG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:WANG
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1127 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2912
Mailing Address - Country:US
Mailing Address - Phone:937-396-0254
Mailing Address - Fax:
Practice Address - Street 1:3535 SOUTHERN BLVD
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-298-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42270207R00000X
OH35089808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35089808OtherOH MEDICAL LICENSE
OH2869276Medicaid
CA00G422700Medicare ID - Type Unspecified
CAA48893Medicare UPIN
OH2869276Medicaid
OH35089808OtherOH MEDICAL LICENSE
OH4249773Medicare PIN