Provider Demographics
NPI:1497892640
Name:CHENG, CHESTER KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:KIM
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:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:DIABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94528-0888
Mailing Address - Country:US
Mailing Address - Phone:925-819-0418
Mailing Address - Fax:
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4904
Practice Address - Country:US
Practice Address - Phone:925-736-0401
Practice Address - Fax:925-736-5609
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA628642086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66901Medicare UPIN