Provider Demographics
NPI:1609033612
Name:CHENG, TOM LOK KWAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:LOK KWAN
Last Name:CHENG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:LOK-KWAN
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1213 WILMETTE AVE.
Mailing Address - Street 2:STE 2C
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091
Mailing Address - Country:US
Mailing Address - Phone:847-323-9297
Mailing Address - Fax:
Practice Address - Street 1:1213 WILMETTE AVE
Practice Address - Street 2:STE 2C
Practice Address - City:WILLMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091
Practice Address - Country:US
Practice Address - Phone:847-323-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000740171100000X
IL198000740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist