Provider Demographics
NPI:1649679366
Name:PAUL P. CHENG MD PC
Entity type:Organization
Organization Name:PAUL P. CHENG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-605-6141
Mailing Address - Street 1:723 W RANDOLPH AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3826
Mailing Address - Country:US
Mailing Address - Phone:580-540-9182
Mailing Address - Fax:580-237-2964
Practice Address - Street 1:723 W RANDOLPH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3826
Practice Address - Country:US
Practice Address - Phone:580-540-9182
Practice Address - Fax:580-237-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18914207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty