Provider Demographics
NPI:1376040162
Name:CHENG, ANDREW K (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:CHENG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N KUAKINI ST STE 1111
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6301
Mailing Address - Country:US
Mailing Address - Phone:808-596-0305
Mailing Address - Fax:808-521-1119
Practice Address - Street 1:405 NO KUAKINI ST
Practice Address - Street 2:SUITE 1111
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6301
Practice Address - Country:US
Practice Address - Phone:808-596-0305
Practice Address - Fax:808-521-1119
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5784213ES0103X
HIPO-242213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI003493Medicaid