Provider Demographics
NPI:1548391667
Name:CHENG, VAN LE (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:LE
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 1:336 ENCINITAS BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-8707
Mailing Address - Country:US
Mailing Address - Phone:858-279-1212
Mailing Address - Fax:858-279-1420
Practice Address - Street 1:336 ENCINITAS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-8707
Practice Address - Country:US
Practice Address - Phone:858-279-1212
Practice Address - Fax:858-279-1420
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABC95755512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP01000776OtherMEDICARE PTAN
CAP00998140OtherRAILROAD MEDICARE PTAN