Provider Demographics
NPI:1356624886
Name:CHENG, LAI-WING
Entity type:Individual
Prefix:MR
First Name:LAI-WING
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 RESEDA CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5204
Mailing Address - Country:US
Mailing Address - Phone:510-770-0953
Mailing Address - Fax:
Practice Address - Street 1:1138 W TENNYSON RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4422
Practice Address - Country:US
Practice Address - Phone:510-293-9031
Practice Address - Fax:510-293-9099
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist