Provider Demographics
NPI:1528188463
Name:CHEONG, TAK CHIO (LAC)
Entity Type:Individual
Prefix:
First Name:TAK CHIO
Middle Name:
Last Name:CHEONG
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 1:6138 157TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1241
Mailing Address - Country:US
Mailing Address - Phone:917-834-0556
Mailing Address - Fax:
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:STE.# 208
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6521
Practice Address - Country:US
Practice Address - Phone:718-886-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002260-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist