Provider Demographics
NPI:1740331636
Name:CHENG, JEAN (MD)
Entity type:Individual
Prefix:
First Name:JEAN
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 1:8990 GARFIELD ST
Mailing Address - Street 2:STE 2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3922
Mailing Address - Country:US
Mailing Address - Phone:951-785-5421
Mailing Address - Fax:951-785-0130
Practice Address - Street 1:8990 GARFIELD ST
Practice Address - Street 2:STE 2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3922
Practice Address - Country:US
Practice Address - Phone:951-785-5421
Practice Address - Fax:951-785-0130
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60710207Q00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A607101Medicaid
CA00A607102Medicaid
CAZZZ21746ZMedicare ID - Type Unspecified
CA00A607101Medicaid
CA4471740001Medicare NSC
CA010062305Medicare ID - Type Unspecified
CAG41476Medicare UPIN
CA4471740001Medicare ID - Type Unspecified
CAA60710Medicare ID - Type Unspecified
CA00A607102Medicaid
CAW15216Medicare ID - Type Unspecified