Provider Demographics
NPI:1366464778
Name:CHENG, IVAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 SE 192ND AVE
Mailing Address - Street 2:STE. 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:STE. 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:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002783171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist