Provider Demographics
NPI:1689379158
Name:CHENG, AMY YAO (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:YAO
Last Name:CHENG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1032 OPUKU ST APT D
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2772
Mailing Address - Country:US
Mailing Address - Phone:808-383-9687
Mailing Address - Fax:
Practice Address - Street 1:13334 LIMONITE AVE STE 130
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-7257
Practice Address - Country:US
Practice Address - Phone:951-407-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant