1801827548 NPI number — MR. SHOW SHAN CHERNG M.D.

Table of content: MR. SHOW SHAN CHERNG M.D. (NPI 1801827548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801827548 NPI number — MR. SHOW SHAN CHERNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERNG
Provider First Name:
SHOW SHAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1801827548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 S AZUSA AVE STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HACIENDA HEIGHTS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91745-6865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-913-3661
Provider Business Mailing Address Fax Number:
626-913-5739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 S AZUSA AVE STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745-6865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-913-3661
Provider Business Practice Location Address Fax Number:
626-913-5739
Provider Enumeration Date:
07/05/2006

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: 207R00000X , with the licence number:  A051502 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A515020 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".