Provider Demographics
NPI:1285665158
Name:YU, CHENG LING (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENG
Middle Name:LING
Last Name:YU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 NORTHLAKE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4108
Mailing Address - Country:US
Mailing Address - Phone:770-934-6464
Mailing Address - Fax:
Practice Address - Street 1:2183 NORTHLAKE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4108
Practice Address - Country:US
Practice Address - Phone:770-934-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16167207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA424835OtherBLUE CROSS BLUE SHIELD
581214923OtherFEI
581214923OtherFEI
P0008401Medicare ID - Type UnspecifiedRAILROAD MEDICARE
16BBBWKMedicare ID - Type Unspecified