Provider Demographics
NPI:1073769089
Name:CHENG, MING MING
Entity Type:Individual
Prefix:
First Name:MING
Middle Name:MING
Last Name:CHENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SATELLITE BLVD
Mailing Address - Street 2:STE# 105
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4760
Mailing Address - Country:US
Mailing Address - Phone:678-957-9960
Mailing Address - Fax:
Practice Address - Street 1:575 W PIKE ST
Practice Address - Street 2:SUITE 15
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7685
Practice Address - Country:US
Practice Address - Phone:770-963-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist