Provider Demographics
NPI:1922589670
Name:LUO, CHENG (NP)
Entity Type:Individual
Prefix:
First Name:CHENG
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5068
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91221-2068
Mailing Address - Country:US
Mailing Address - Phone:818-242-3333
Mailing Address - Fax:323-564-8578
Practice Address - Street 1:1106 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2606
Practice Address - Country:US
Practice Address - Phone:818-242-3333
Practice Address - Fax:818-552-2722
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010581208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice