Provider Demographics
NPI:1982674339
Name:CHENG, REX LEE (MD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:LEE
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 1:8 CALLE ANACAPA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6867
Mailing Address - Country:US
Mailing Address - Phone:562-712-2974
Mailing Address - Fax:310-222-5252
Practice Address - Street 1:8 CALLE ANACAPA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6867
Practice Address - Country:US
Practice Address - Phone:562-712-2974
Practice Address - Fax:310-222-5252
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72629207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G726290Medicaid
CAWG72629DMedicare ID - Type UnspecifiedPPIN
CAWG72629EMedicare ID - Type UnspecifiedPPIN
CA00G726290Medicaid
CAF89546Medicare UPIN