Provider Demographics
NPI:1891497525
Name:CHENG, ANGUS (DO)
Entity type:Individual
Prefix:
First Name:ANGUS
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4903
Mailing Address - Country:US
Mailing Address - Phone:626-782-9391
Mailing Address - Fax:
Practice Address - Street 1:3430 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-3104
Practice Address - Country:US
Practice Address - Phone:626-782-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-10-01
Deactivation Date:2024-09-23
Deactivation Code:
Reactivation Date:2024-09-30
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A23417208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program