Provider Demographics
NPI:1609854132
Name:CHENG, EMIL S (MD)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:S
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 1:5770 S 250 E STE 235
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6191
Mailing Address - Country:US
Mailing Address - Phone:801-314-5114
Mailing Address - Fax:801-314-5111
Practice Address - Street 1:5770 S 250 E STE 235
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6191
Practice Address - Country:US
Practice Address - Phone:801-314-5114
Practice Address - Fax:801-314-5111
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0614208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00480282Medicaid
341430804Medicare ID - Type Unspecified
NM00480282Medicaid