Provider Demographics
NPI:1194082941
Name:CHENG, EDWARD L (LAC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:L
Last Name:CHENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:LI LI EDWARD
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:27121 174TH PL SE STE 102
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4939
Mailing Address - Country:US
Mailing Address - Phone:253-486-3839
Mailing Address - Fax:
Practice Address - Street 1:27121 174TH PL SE STE 102
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4939
Practice Address - Country:US
Practice Address - Phone:253-486-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14641171100000X
WAAC60302372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist