1396738233 NPI number — DAVID CHENG MD

Table of content: DAVID CHENG MD (NPI 1396738233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396738233 NPI number — DAVID CHENG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENG
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396738233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 SOUTHWYCK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43614-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-288-8325
Provider Business Mailing Address Fax Number:
419-866-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-8481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-757-6322
Provider Business Practice Location Address Fax Number:
219-757-5891
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  036093981 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 01050183A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000649197 . This is a "BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 5497426002 . This is a "CIGNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351173213 . This is a "HFN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 5273524 . This is a "CCN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00816099 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01630255 . This is a "BCBC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 200856740 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82435 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100162290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100356620 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351173213 . This is a "ISPAT/INLAND" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351173213 . This is a "SAGAMORE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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