Provider Demographics
NPI:1710959440
Name:CHENG, YAN YAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YAN YAN
Middle Name:
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 1:5505 N MESA ST STE 2
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5464
Mailing Address - Country:US
Mailing Address - Phone:915-213-3262
Mailing Address - Fax:866-867-8390
Practice Address - Street 1:5505 N MESA ST STE 2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5464
Practice Address - Country:US
Practice Address - Phone:915-213-3262
Practice Address - Fax:866-867-8390
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD235922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273872Medicaid
OR273872Medicaid
H50709Medicare UPIN