Provider Demographics
NPI:1770621641
Name:CHENG, GEORGE Y (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:Y
Last Name:CHENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1239 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2601
Mailing Address - Country:US
Mailing Address - Phone:310-513-1591
Mailing Address - Fax:310-513-0698
Practice Address - Street 1:1239 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2601
Practice Address - Country:US
Practice Address - Phone:310-513-1591
Practice Address - Fax:310-513-0698
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4132OtherCALIFORNIA LICENSE NUMBER
CA4891319Medicare UPIN