Provider Demographics
NPI:1992978332
Name:MERIDIAN THERAPEUTICS
Entity type:Organization
Organization Name:MERIDIAN THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:360-253-7696
Mailing Address - Street 1:3425 SE 192ND AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1466
Mailing Address - Country:US
Mailing Address - Phone:360-253-7696
Mailing Address - Fax:
Practice Address - Street 1:3425 SE 192ND AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1466
Practice Address - Country:US
Practice Address - Phone:360-253-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002783171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty