Basic Information
| Provider Information | |||||||||
| NPI: | 1922762079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHA | ||||||||
| FirstName: | CHENG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2377 S PLAYA AVE | ||||||||
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| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937276360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593602003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 MALL DR | ||||||||
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| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932305786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595829000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2021 | ||||||||
| LastUpdateDate: | 10/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471C3402X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | 2471C3401X | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography |
No ID Information.