Provider Demographics
NPI:1376836130
Name:CHENG, YUANYUAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:YUANYUAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
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:PO BOX 520190
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-0190
Mailing Address - Country:US
Mailing Address - Phone:718-886-9236
Mailing Address - Fax:
Practice Address - Street 1:14201 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6551
Practice Address - Country:US
Practice Address - Phone:718-886-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist