Basic Information
Provider Information
NPI: 1477754380
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHENG
FirstName: CYNTHIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1855 W REDLANDS BLVD
Address2:  
City: REDLANDS
State: CA
PostalCode: 923733145
CountryCode: US
TelephoneNumber: 9098900407
FaxNumber: 9098900575
Practice Location
Address1: 17577 ARROW BLVD
Address2:  
City: FONTANA
State: CA
PostalCode: 923354011
CountryCode: US
TelephoneNumber: 9098234454
FaxNumber: 9098236918
Other Information
ProviderEnumerationDate: 05/29/2007
LastUpdateDate: 09/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA88987CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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