Provider Demographics
NPI:1043790678
Name:CHENG, CHIYUAN (DC)
Entity Type:Individual
Prefix:
First Name:CHIYUAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 CAPE HORN PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1572
Mailing Address - Country:US
Mailing Address - Phone:626-203-1419
Mailing Address - Fax:
Practice Address - Street 1:1101 S WINCHESTER BLVD STE D138
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3914
Practice Address - Country:US
Practice Address - Phone:408-394-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor