Provider Demographics
NPI:1215109319
Name:CHEN, CHENG SHU (LAC)
Entity type:Individual
Prefix:
First Name:CHENG
Middle Name:SHU
Last Name:CHEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2275
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92654-2275
Mailing Address - Country:US
Mailing Address - Phone:949-916-8868
Mailing Address - Fax:949-218-0985
Practice Address - Street 1:25411 CABOT RD STE 102
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5517
Practice Address - Country:US
Practice Address - Phone:949-916-8868
Practice Address - Fax:949-218-0985
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4830171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist