Provider Demographics
NPI:1699822411
Name:ONG, CHERI (MD)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:ONG
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 1:6300 E EL DORADO PLZ
Mailing Address - Street 2:STE A220
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4612
Mailing Address - Country:US
Mailing Address - Phone:520-750-7166
Mailing Address - Fax:
Practice Address - Street 1:3170 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1227
Practice Address - Country:US
Practice Address - Phone:520-298-2325
Practice Address - Fax:520-298-2328
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ38198208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ366784Medicaid
AZZ127641Medicare PIN