Provider Demographics
NPI:1528442035
Name:CHENG, KAI-YUAN (DOM)
Entity type:Individual
Prefix:DR
First Name:KAI-YUAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BELLAMAH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-2133
Mailing Address - Country:US
Mailing Address - Phone:505-377-9835
Mailing Address - Fax:
Practice Address - Street 1:1240 BELLAMAH AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2133
Practice Address - Country:US
Practice Address - Phone:505-377-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist