Provider Demographics
NPI:1740540558
Name:CHENG, GORDON CHIH-JEN (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:CHIH-JEN
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 1:12036 SCRIPPS HIGHLANDS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-5155
Mailing Address - Country:US
Mailing Address - Phone:858-566-4444
Mailing Address - Fax:
Practice Address - Street 1:12036 SCRIPPS HIGHLANDS DR
Practice Address - Street 2:STE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-5155
Practice Address - Country:US
Practice Address - Phone:858-566-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-26
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127844208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics